OLR Bill Analysis

sHB 5233

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR TOMOSYNTHESIS FOR BREAST CANCER SCREENINGS.

SUMMARY:

This bill requires certain Connecticut health insurance policies to cover, at the option of the covered woman, mammograms provided by breast tomosynthesis. Breast tomosynthesis is a three-dimensional mammographic method. By law, such policies must cover baseline mammograms for women age 35 through 39, and annual mammograms for women age 40 or older.

The bill applies to (1) individual or group health insurance policies that cover (a) basic hospital expenses; (b) basic medical-surgical expenses; (c) major medical expenses; or (d) hospital or medical services, including those provided under an HMO plan; and (2) individual health insurance policies that provide limited benefit health coverage. Because of the federal Employee Retirement Income Security Act, state insurance benefit mandates do not apply to self-insured benefit plans.

EFFECTIVE DATE: January 1, 2017

BACKGROUND

Related Federal Law

The federal Affordable Care Act (P.L. 111-148) allows states to require health plans sold through the state's health insurance exchange to offer benefits beyond those included in the required essential health benefits, provided the state defrays the cost of those additional benefits. The requirement applies to state benefit mandates enacted after December 31, 2011. Thus, the state must pay the insurance carrier or enrollee to defray the cost of any new benefits it mandates after that date.

Related Bill

sHB 158, reported favorably by the Insurance and Real Estate Committee, prohibits certain health insurance policies from (1) charging copays or imposing deductibles for mammograms and comprehensive breast ultrasound exams and (2) placing annual or lifetime dollar or visitation limits on these services.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

17

Nay

1

(03/17/2016)