INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES, the official text

S2032 2026 -- S 2032 ======== LC003440 ======== STATE OF RHODE ISLAND IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 2026 ____________ A N A C T RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES Introduced By: Senators Zurier, Sosnowski, Murray, Tikoian, Urso, Lauria, Thompson, Valverde, Ujifusa, and Appollonio Date Introduced: January 09, 2026 Referred To: Senate Health & Human Services It is enacted by the General Assembly as follows: 1 SECTION 1. Chapter 27-18 of the General Laws entitled Accident and Sickness Insurance 2 Policies is hereby amended by adding thereto the following section: 3 27-18-42.1. Diagnostic and supplemental breast examination. 4 (a) As used in this section, the following words shall have the following meanings: 5 (1) Cost-sharing requirements means a deductible, coinsurance, copayment and any 6 maximum limitation on the application of such a deductible, coinsurance, copayment or similar 7 out-of-pocket expense. 8 (2) Diagnostic breast examinations means a medically necessary and appropriate 9 examination of the breast, including an examination using diagnostic mammography, breast 10 magnetic resonance imaging, or breast ultrasound, that is: 11 (i) Used to evaluate an abnormality seen or suspected from a screening examination for 12 breast cancer; or 13 (ii) Used to evaluate an abnormality detected by another means of examination. 14 (3) Supplemental breast examinations means a medically necessary and appropriate 15 examination of the breast, including an examination using breast magnetic resonance imaging, or 16 breast ultrasound, that is: 17 (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 18 (ii) Based on personal or family medical history, or additional factors that may increase the 19 individual’s risk of breast cancer. 1 (b) In the case that a group health plan, or a health insurance issuer offering group or 2 individual health insurance coverage, that provides benefits with respect to screening, supplemental 3 and diagnostic breast examinations furnished to an individual enrolled under such plan or such 4 coverage, the plan or coverage shall not impose any cost-sharing requirements. 5 SECTION 2. Chapter 27-19 of the General Laws entitled Nonprofit Hospital Service 6 Corporations is hereby amended by adding thereto the following section: 7 27-19-34.2. Diagnostic and supplemental breast examination. 8 (a) As used in this section, the following words shall have the following meanings: 9 (1) Cost-sharing requirements means a deductible, coinsurance, copayment and any 10 maximum limitation on the application of such a deductible, coinsurance, copayment or similar 11 out-of-pocket expense. 12 (2) Diagnostic breast examinations means a medically necessary and appropriate 13 examination of the breast, including an examination using diagnostic mammography, breast 14 magnetic resonance imaging, or breast ultrasound, that is: 15 (i) Used to evaluate an abnormality seen or suspected from a screening examination for 16 breast cancer; or 17 (ii) Used to evaluate an abnormality detected by another means of examination. 18 (3) Supplemental breast examinations means a medically necessary and appropriate 19 examination of the breast, including an examination using breast magnetic resonance imaging, or 20 breast ultrasound, that is: 21 (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 22 (ii) Based on personal or family medical history, or additional factors that may increase the 23 individual’s risk of breast cancer. 24 (b) In the case that a group health plan, or a health insurance issuer offering group or 25 individual health insurance coverage, that provides benefits with respect to screening, supplemental 26 and diagnostic breast examinations furnished to an individual enrolled under such plan or such 27 coverage, the plan or coverage shall not impose any cost-sharing requirements. 28 SECTION 3. Chapter 27-20 of the General Laws entitled Nonprofit Medical Service 29 Corporations is hereby amended by adding thereto the following section: 30 27-20-17.2. Diagnostic and supplemental breast examination. 31 (a) As used in this section, the following words shall have the following meanings: 32 (1) Cost-sharing requirements means a deductible, coinsurance, copayment and any 33 maximum limitation on the application of such a deductible, coinsurance, copayment or similar 34 out-of-pocket expense. LC003440 - Page 2 of 5 1 (2) Diagnostic breast examinations means a medically necessary and appropriate 2 examination of the breast, including an examination using diagnostic mammography, breast 3 magnetic resonance imaging, or breast ultrasound, that is: 4 (i) Used to evaluate an abnormality seen or suspected from a screening examination for 5 breast cancer; or 6 (ii) Used to evaluate an abnormality detected by another means of examination. 7 (3) Supplemental breast examinations means a medically necessary and appropriate 8 examination of the breast, including an examination using breast magnetic resonance imaging, or 9 breast ultrasound, that is: 10 (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 11 (ii) Based on personal or family medical history, or additional factors that may increase the 12 individual’s risk of breast cancer. 13 (b) In the case that a group health plan, or a health insurance issuer offering group or 14 individual health insurance coverage, that provides benefits with respect to screening, supplemental 15 and diagnostic breast examinations furnished to an individual enrolled under such plan or such 16 coverage, the plan or coverage shall not impose any cost-sharing requirements. 17 SECTION 4. Chapter 27-41 of the General Laws entitled Health Maintenance 18 Organizations is hereby amended by adding thereto the following section: 19 27-41-30.2. Diagnostic and supplemental breast examination. 20 (a) As used in this section, the following words shall have the following meanings: 21 (1) Cost-sharing requirements means a deductible, coinsurance, copayment and any 22 maximum limitation on the application of such a deductible, coinsurance, copayment or similar 23 out-of-pocket expense. 24 (2) Diagnostic breast examinations means a medically necessary and appropriate 25 examination of the breast, including an examination using diagnostic mammography, breast 26 magnetic resonance imaging, or breast ultrasound, that is: 27 (i) Used to evaluate an abnormality seen or suspected from a screening examination for 28 breast cancer; or 29 (ii) Used to evaluate an abnormality detected by another means of examination. 30 (3) Supplemental breast examinations means a medically necessary and appropriate 31 examination of the breast, including an examination using breast magnetic resonance imaging, or 32 breast ultrasound, that is: 33 (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and 34 (ii) Based on personal or family medical history, or additional factors that may increase the LC003440 - Page 3 of 5 1 individual’s risk of breast cancer. 2 (b) In the case that a group health plan, or a health insurance issuer offering group or 3 individual health insurance coverage, that provides benefits with respect to screening, supplemental 4 and diagnostic breast examinations furnished to an individual enrolled under such plan or such 5 coverage, the plan or coverage shall not impose any cost-sharing requirements. 6 SECTION 5. This act shall take effect on January 1, 2027. ======== LC003440 ======== LC003440 - Page 4 of 5 EXPLANATION BY THE LEGISLATIVE COUNCIL OF A N A C T RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES *** 1 This act would prohibit an insurance company from imposing any cost-sharing 2 requirements for any diagnostic or supplemental breast examinations. 3 This act would take effect on January 1, 2027. ======== LC003440 ======== LC003440 - Page 5 of 5