SB 838 — AN ACT CONCERNING VISION PLANS, OPTOMETRISTS AND OPHTHALMOLOGISTS.

General Assembly RaisedSubstitute Bill No.

838 January Session, 2019 LCOAN No.ACT CONCERNING REQUIRED HEALTH INSURANCE COVERAGE AND COST-SHARING FOR MAMMOGRAMS AND BREAST ULTRASOUNDS.

4030 Referred to Committee on INSURANCE AND REAL ESTATE Introduced by:

(INS) AN ACT CONCERNING REQUIRED HEALTH INSURANCE COVERAGE AND COST-SHARING FOR MAMMOGRAMS AND BREAST ULTRASOUNDS.

(A) A baseline mammogram, which may be provided by breast tomosynthesis at the option of the woman covered under the policy, for any woman who is [thirty-fivethirty-five to thirty- nine]nine thirty years of ageage, [,inclusive; inclusive] or older;

and (B) if recommended by such woman's treating physician, a mammogram, which may be provided by breast tomosynthesis at the option of the woman covered LCOunder No.the policy, every year for any woman who is forty years of age or older.

4030 1 of 5 Raised Bill No.838 under the policy, every year for any woman who (i) is [forty] thirty years of age or older, (ii) has a family history or prior personal history of breast cancer, or (iii) has a prior personal history of breast disease diagnosed through biopsy as benign.

(A) Comprehensive ultrasound screening of an entire breast or breastsLCO if:\\PRDFS1\SCOUSERS\FORZANOF\WS\2019SB-00838-R01 of 4 SB.docx Substitute Bill No.

838 breasts if:

or (iii) such screening is recommended by a woman's treating physician for a woman who (I) is thirtyforty years of age or older, (II) has a family history or prior personal history of breast cancer, or (III) has a prior personal history of breast disease diagnosed through biopsy as benign;

The provisions of this subsection shall apply to a high deductible plan, as that term is used in subsection (f) of section 38a-493, to the maximum extent permitted by federal law, except if such plan is used to establish a healthmedical savings account,account asor thatan termArcher isMSA usedpursuant into Section 223220 of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as amended from time to LCOtime, No.or a health savings account pursuant to Section 223 of said Internal Revenue Code, as amended from time to time, the provisions of this subsection shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223, as applicable.

4030 2 of 5 Raised Bill No.838 time, the provisions of this subsection shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 223.

Subsections (b) and (c) of section 38a-530 of the general statutesLCO are{\\PRDFS1\SCOUSERS\FORZANOF\WS\2019SB-00832 repealedof and4 theR02-SB.docx following} isSubstitute substitutedBill inNo. lieu thereof (Effective January 1, 2020):

838 statutes are repealed and the following is substituted in lieu thereof (Effective January 1, 2020):

(A) A baseline mammogram, which may be provided by breast tomosynthesis at the option of the woman covered under the policy, for any woman who is [thirty-fivethirty-five to thirty-nine]thirty-nine thirty years of ageage, [,inclusive; inclusive] or older;

and (B) if recommended by such woman's treating physician, a mammogram, which may be provided by breast tomosynthesis at the option of the woman covered under the policy, every year for any woman who (i) is [forty]forty thirty years of age or older,older. (ii) has a family history or prior personal history of breast cancer, or (iii) has a prior personal history of breast disease diagnosed through biopsy as benign.

or (iii) such screening is recommended by a woman's treating physician for a woman who (I) is LCOforty No.years of age or older, (II) has a family history or prior personal history of breast cancer, or (III) has a prior personal history of breast disease diagnosed through biopsy as benign;

4030 3 of 5 Raised Bill No.838 thirty years of age or older, (II) has a family history or prior personal history of breast cancer, or (III) has a prior personal history of breast disease diagnosed through biopsy as benign;

(c) Benefits under this section shall be subject to any policy provisions that apply to other services covered by such policy, except thatLCO no{\\PRDFS1\SCOUSERS\FORZANOF\WS\2019SB-00833 such policy shall impose a coinsurance, copayment, [that exceeds a maximum of twenty4 dollarsR02-SB.docx for} anSubstitute ultrasoundBill screeningNo. under subparagraph (A) of subdivision (2) of subsection (b) of this section] deductible or other out-of-pocket expense for such benefits.

The838 provisionsthat ofno thissuch subsectionpolicy shall applyimpose to a highcoinsurance, deductiblecopayment, plan,[that asexceeds thata termmaximum is used in subsection (f) of sectiontwenty 38a-493,dollars tofor thean maximumultrasound extentscreening permittedunder bysubparagraph federal(A) law, except if such plan is used to establish a health savings account, as that term is used in Section 223 of thesubdivision Internal(2) Revenue Code of 1986subsection or(b) any subsequent corresponding internal revenue code of the United States, as amended from time to time, the provisions of this subsectionsection] shalldeductible applyor toother suchout-of-pocket planexpense tofor the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such accountbenefits. for the deduction allowed under said Section 223.

The provisions of this subsection shall apply to a high deductible plan, as that term is used in subsection (f) of section 38a-520, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code, as amended from time to time, the provisions of this subsection shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223, as applicable.

2 January 1, 2020 38a-530(b) and (c) StatementINS ofJoint Purpose:Favorable Subst.

ToAPP (1)Joint eliminateFavorable cost-sharingLCO for{\\PRDFS1\SCOUSERS\FORZANOF\WS\2019SB-00838- certain4 mammograms and breast ultrasounds, and (2) require health insurance coverage for (A) a baseline mammogram for any woman who is thirty years of age4 orR02-SB.docx older,} (B) an annual mammogram for any woman who receives a recommendation from such woman's treating physician and (i) is LCO No.

4030 4 of 5 Raised Bill No.

838 thirty years of age or older, (ii) has a family history or prior personal history of breast cancer, or (iii) has a prior personal history of breast disease diagnosed through biopsy as benign, and (C) comprehensive breast ultrasound screening for any woman who receives a recommendation from such woman's treating physician and (i) is thirty years of age or older, (ii) has a family history or prior personal history of breast cancer, or (iii) has a prior personal history of breast disease diagnosed through biopsy as benign.

[Proposed deletions are enclosed in brackets.

Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.] LCO No.

4030 5 of 5