OLR Bill Analysis
AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR BREAST MAGNETIC RESONANCE IMAGING.
This bill resolves a statutory conflict by removing a requirement that certain insurance policies cover magnetic resonance imaging (MRI) in all circumstances in accordance with guidelines established by the American Cancer Society or the American College of Radiology.
By law, unchanged by the bill, certain insurance policies must cover a breast MRI, but only if a (1) mammogram shows heterogeneous or dense breast tissue based on the American College of Radiology's Breast Imaging Reporting and Database System (BI-RADS) or (2) woman is considered to be at an increased breast cancer risk because of family history, her own breast cancer history, positive genetic testing, or other indications determined by her physician or advanced-practice registered nurse.
The bill and law apply to individual and group health insurance policies that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including those provided by HMOs. They also apply to individual policies that cover limited benefit health coverage. (Due to the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans. )
EFFECTIVE DATE: Upon passage
The American College of Radiology collaborated with the National Cancer Institute, the Centers for Disease Control and Prevention, the American Medical Association, and others to develop BI-RADS, which is used to standardize mammography reporting. There are two BI-RADS scales: one characterizes breast density and the other characterizes a radiologist's reading of what he or she sees on a mammogram. By law, a patient's mammography report must include information about breast density based on BI-RADS.
sSB 97, favorably reported by the Insurance and Real Estate Committee on February 28, 2012, resolves the statutory conflict in a different way. It removes the requirements that health insurance policies cover breast MRI (1) for a woman with dense breast tissue or an increased risk of breast cancer and (2) in accordance with American College of Radiology. It retains the requirement that policies cover breast MRI in accordance with American Cancer Society guidelines.
Insurance and Real Estate Committee