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Senate Engrossed
insurance; cost sharing; breast exams |
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State of Arizona Senate Fifty-seventh Legislature Second Regular Session 2026
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SENATE BILL 1165 |
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AN ACT
amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.21; amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20-1376.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11; relating to health insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-841.14, to read:
20-841.14. Breast examinations; cost sharing; exception; definitions
A. a hospital service corporation or medical service corporation that issues, amends, delivers or renews a subscription contract On or after January 1, 2027 may not impose cost sharing requirements for PREVENTATIVE SCREENING SERVICES FOR BREAST CANCER OR FOR ADDITIONAL SCREENING SERVICES REQUIRED TO COMPLETE THE SCREENING CONTINUUM.
b. If a subscription contract includes a high deductible health plan as defined in 26 United States Code section 223(c)(2)(a), subsection A of this section applies after the deductible is met, except that if the items or services are preventive as prescribed in 26 United States Code section 223(c)(2)(C), subsection A of this section applies regardless of whether the minimum deductible under 26 United States Code section 223 has been met.
C. For the purposes of this section:
1. "aDDITIONAL SCREENING SERVICES" INCLUDES A DIAGNOSTIC BREAST EXAMINATION AND A SUPPLEMENTAL BREAST EXAMINATION.
2. "Cost sharing" means a deductible, coinsurance, copayment or maximum limitation on the application of the deductible, coinsurance, copayment or similar out-of-pocket expense.
3. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is used to either:
(i) Evaluate an abnormality that is seen or suspected from a screening examination for breast cancer.
(ii) Evaluate an abnormality that is detected by another means of examination.
4. "pREVENTATIVE SCREENING SERVICE FOR BREAST CANCER" MEANS SCREENING MAMMOGRAPHY AS DEFINED IN SECTION 30-651.
5. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is both:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history or additional factors that increase an individual's risk of breast cancer, including heterogenous or extremely dense breasts.
Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.21, to read:
20-1057.21. Breast examinations; cost sharing; exception; definitions
A. a health care services organization that issues, amends, delivers or renews an evidence of coverage On or after January 1, 2027 may not impose cost sharing requirements for PREVENTATIVE SCREENING SERVICES FOR BREAST CANCER OR FOR ADDITIONAL SCREENING SERVICES REQUIRED TO COMPLETE THE SCREENING CONTINUUM.
B. If an evidence of coverage includes a high deductible health plan as defined in 26 United States Code section 223(c)(2)(a), subsection A of this section applies after the deductible is met, except that if the items or services are preventive as prescribed in 26 United States Code section 223(c)(2)(C), subsection A of this section applies regardless of whether the minimum deductible under 26 United States Code section 223 has been met.
c. For the purposes of this section:
1. "additional screening services" includes a diagnostic breast examination and a supplemental breast examination.
2. "Cost sharing" means a deductible, coinsurance, copayment or maximum limitation on the application of the deductible, coinsurance, copayment or similar out-of-pocket expense.
3. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is used to either:
(i) Evaluate an abnormality that is seen or suspected from a screening examination for breast cancer.
(ii) Evaluate an abnormality that is detected by another means of examination.
4. "preventative screening services for breast cancer" means screening mammography as defined in section 30-651.
5. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is both:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history or additional factors that increase an individual's risk of breast cancer, including heterogenous or extremely dense breasts.
Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1376.11, to read:
20-1376.11. Breast examinations; cost sharing; exception; definitions
A. a disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2027 may not impose cost sharing requirements for preventative screening services for breast cancer or for additional screening services required to complete the screening continuum.
b. If a policy includes a high deductible health plan as defined in 26 United States Code section 223(c)(2)(a), subsection A of this section applies after the deductible is met, except that if the items or services are preventive as prescribed in 26 United States Code section 223(c)(2)(C), subsection A of this section applies regardless of whether the minimum deductible under 26 United States Code section 223 has been met.
c. For the purposes of this section:
1. "additional screening services" includes a diagnostic breast examination and a supplemental breast examination.
2. "Cost sharing" means a deductible, coinsurance, copayment or maximum limitation on the application of the deductible, coinsurance, copayment or similar out-of-pocket expense.
3. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is used to either:
(i) Evaluate an abnormality that is seen or suspected from a screening examination for breast cancer.
(ii) Evaluate an abnormality that is detected by another means of examination.
4. "preventative screening services for breast cancer" means screening mammography as defined in section 30-651.
5. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is both:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history or additional factors that increase an individual's risk of breast cancer, including heterogenous or extremely dense breasts.
Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.11, to read:
20-1406.11. Breast examinations; cost sharing; exception; definitions
A. a group or blanket disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2027 may not impose cost sharing requirements for preventative screening services for breast cancer or for additional screening services required to complete screening continuum.
b. If a policy includes a high deductible health plan as defined in 26 United States Code section 223(c)(2)(a), subsection A of this section applies after the deductible is met, except that if the items or services are preventive as prescribed in 26 United States Code section 223(c)(2)(C), subsection A of this section applies regardless of whether the minimum deductible under 26 United States Code section 223 has been met.
c. For the purposes of this section:
1. "additional screening services" includes a diagnostic breast examination and a supplemental breast examination.
2. "Cost sharing" means a deductible, coinsurance, copayment or maximum limitation on the application of the deductible, coinsurance, copayment or similar out-of-pocket expense.
3. "Diagnostic Breast Examination":
(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is used to either:
(i) Evaluate an abnormality that is seen or suspected from a screening examination for breast cancer.
(ii) Evaluate an abnormality that is detected by another means of examination.
4. "preventative screening services for breast cancer" means screening mammography as defined in section 30-651.
5. "Supplemental breast examination":
(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
(b) Includes an examination of the breast using contrast enhanced mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is both of the following:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
(ii) Based on a personal or family medical history or additional factors that increase an individual's risk of breast cancer, including heterogenous or extremely dense breasts.