OLR Bill Analysis

sSB 97



This bill prohibits certain health insurance policies from imposing out-of-pocket expenses (e. g. , coinsurance, copayment, or deductible) on breast ultrasound screening. But this prohibition does not apply to high deductible health plans designed to be compatible with federally qualified health savings accounts. By law, the policies must cover breast ultrasound screening if a:

1. mammogram shows heterogeneous or dense breast tissue based on the American College of Radiology's Breast Imaging Reporting and Database System 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 advance-practice registered nurse.

The bill also resolves a statutory conflict regarding coverage of breast magnetic resonance imaging (MRI) by removing a requirement in current law that a policy cover a breast MRI under the same circumstances as ultrasound screening (i. e. , dense breast tissue or a woman's increased risk of breast cancer). Current law also requires MRI coverage in all circumstances according to guidelines established by the American Cancer Society or the American College of Radiology. This bill removes reference to the American College of Radiology. Thus, it requires policies to cover breast MRI in accordance with American Cancer Society guidelines.

EFFECTIVE DATE: January 1, 2013


The bill applies 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. )


Related Bill

SB 12, favorably reported by the Insurance and Real Estate Committee on February 21, 2012, resolves the MRI statutory conflict differently than sSB 97 does. SB 12 removes the requirement that certain insurance policies cover MRIs in accordance with guidelines established by the American Cancer Society or the American College of Radiology but continues to require that the policies cover breast MRIs when a mammogram shows dense breast tissue or a woman is at an increased risk of breast cancer.


Insurance and Real Estate Committee

Joint Favorable Substitute