Mass. Gen. Laws ch. 176G § 4SS

Current through Chapter 244 of the 2024 Legislative Session

Section 176G:4SS - [Effective 2/11/2025] Coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening and medically necessary and appropriate screening with breast magnetic resonance imaging or screening breast ultrasound

(a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-

"Cost sharing", a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

"Diagnostic examinations for breast cancer", a medically necessary and appropriate examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected from a screening examination for breast cancer, detected by another means of examination or suspected based on the medical history or family medical history of the individual.

"Examination for breast cancer", an examination used to evaluate an abnormality in a breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance imaging or breast ultrasound.

"HSA-qualified health insurance policy", a policy of individual or group health insurance coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as implemented and interpreted by the United States Department of the Treasury in the regulations and guidance in effect at the time the policy is issued.

(b) Any individual or group health maintenance contract that provides coverage for screening mammograms shall provide coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening and medically necessary and appropriate screening with breast magnetic resonance imaging or screening breast ultrasound on a basis not less favorable than screening mammograms that are covered as medical benefits. There shall be no increase in patient cost sharing for:

(i) screening mammograms;

(ii) digital breast tomosynthesis;

(iii) screening breast magnetic resonance imaging;

(iv) screening breast ultrasound; or

(v) diagnostic examinations for breast cancer.

(c)

(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required under any general or special law to the extent that the exemption is necessary to allow the policy to be an HSA-qualified health insurance policy.

(2) The exemption provided in paragraph (1) shall not apply to any coverage required under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223, with respect to any HSA-qualified health insurance policy issued, delivered, amended or renewed while such regulation or guidance is effective.

Mass. Gen. Laws ch. 176G, § 176G:4SS

Added by Acts 2024, c. 231,§ 6, eff. 2/11/2025, app. to all contracts entered into, renewed or amended on or after 1/1/2026.