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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
Senate: FIN DPA 5-1-1-0 | Third Read 27-2-1-0-0House: HHS DP 12-0-0-0 |
SB 1165: insurance; cost sharing; breast exams
Sponsor: Senator Angius, LD 30
Caucus & COW
Overview
Effective for contracts, evidence of coverage and policies issued on or after January 1, 2027, prohibits a hospital or medical service corporation, health care services organization, disability insurer and group or blanket disability insurer (health care insurer) from imposing cost sharing requirements for preventative screening services for breast cancer or for additional screening services required to complete the screening continuum.
History
The Department of Insurance and Financial Institutions regulates policies, certificates, evidence of coverage and contracts of insurance (insurance policies) that are issued or delivered by health care insurers. Health care insurers include disability insurers, group disability insurers, blanket disability insurers, health care services organizations, hospital service corporations and medical service corporations (A.R.S. § 20-1379).
Federal law defines high-deductible health plan as a health plan that has an annual deductible which is not less than a specified amount and for which the sum of the annual deductible and the other annual out-of-pocket expenses required to be paid under the plan for covered benefits does not exceed a separate specified limit (26 U.S.C. § 223).
Federal law permits a high-deductible health plan to provide coverage for preventive care without a deductible while maintaining the plan's legal status for health savings account eligibility. In 2024, the Internal Revenue Service expanded the list of preventive care benefits to be provided by a high-deductible health plan without a deductible, or with a deductible below the applicable minimum deductible for the high-deductible health plan, to include all types of breast cancer screening for individuals who have not been diagnosed with breast cancer (IRS Notice 2024-75).
Provisions
1. Prohibits a health care insurer that issues, amends, delivers or renews an insurance policy on or after January 1, 2027, from imposing cost sharing requirements for preventative screening services for breast cancer or for additional screening services required to complete the screening continuum, including a diagnostic breast examination and a supplemental breast examination. (Sec. 1-4)
2. Provides that, for insurance policies that include a high-deductible health plan, the cost-sharing prohibition applies after the deductible has been satisfied, except that for preventive items or services, the prohibition applies regardless of whether the minimum deductible has been met. (Sec. 1-4)
3. Defines additional screening services to include a diagnostic breast examination and a supplemental breast examination. (Sec. 1-4)
4. Defines cost sharing as a deductible, coinsurance, copayment or maximum limitation on the application of the deductible, coinsurance, copayment or similar out-of-pocket expense. (Sec. 1-4)
5. Defines diagnostic breast examination as a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines and includes a breast examination using contrast enhanced mammography, diagnostic mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is used to either:
a. evaluate an abnormality that is seen or suspected from a screening examination for breast cancer; or
b. evaluate an abnormality that is detected by another means of examination. (Sec. 1-4)
6. Defines preventative screening services for breast cancer as a screening mammography, which means x-ray imaging of the breast of asymptomatic persons and includes digital breast tomosynthesis. (Sec. 1-4)
7. Defines supplemental breast examination as a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines and includes a breast examination using contrast enhanced mammography, breast magnetic resonance imaging or breast ultrasound or molecular breast imaging that is both:
a. used to screen for breast cancer when there is no abnormality seen or suspected; and
b. 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. 1-4)
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Initials AG SB 1165
3/5/2026 Page 0 Caucus & COW
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