 |
ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AMENDED
insurance; cost sharing; breast exams
Purpose
Prohibits, for contracts, evidences of coverage and policies issued on or after January 1, 2027, a hospital or medical service corporation, health care services organization, disability insurer and group or blanket disability insurer (health insurer) from imposing cost sharing requirements for preventative screening services for breast cancer or for additional screening services required to complete the screening continuum.
Background
The Department of Insurance and Financial Institutions regulates policies, certificates, evidences 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).
Statute requires that health insurance contracts providing coverage for mastectomy surgical services also provide coverage for preventive mammography screening and diagnostic imaging performed on dedicated equipment for diagnostic purposes on referral by a patient's physician subject to the terms and conditions of the policy, including deductibles and coinsurance (A.R.S. §§ 20-826; 20-1057; 20-1342; and 20-1402).
Federal law defines high deductible health plan (HDHP) 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 allows an HDHP to provide coverage for preventive care without a deductible while maintaining the plan's legal status for health savings account (HSA) eligibility. In 2024, the Internal Revenue Service expanded the list of preventive care benefits to be provided by an HDHP without a deductible, or with a deductible below the applicable minimum deductible for the HDHP, to include all types of breast cancer screening for individuals who have not been diagnosed with breast cancer (IRS Notice 2024-75).
If prohibiting health insurers from imposing cost-sharing requirements for preventative screening services for breast cancer or for additional screening services required to complete the screening continuum results in a change to employer contributions for the state employee health plan, there may be a fiscal impact to the state General Fund.
Provisions
2. Applies, if an insurance policy includes an HDHP, the cost sharing prohibition after the deductible is met, except that if the items or services are preventive, the prohibition applies regardless of whether the minimum deductible has been met.
3. 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.
4. Defines additional screening services to include a diagnostic breast examination and a supplemental breast examination.
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.
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.
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.
8. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Modifies the prohibition on a health insurer by prohibiting cost sharing for preventative screening services for breast cancer and for additional screening services required to complete the screening continuum, rather than only prohibiting cost sharing for diagnostic and supplemental breast examinations.
2. Defines additional screening and preventative screening service for breast cancer.
3. Makes conforming changes.
Senate Action
FIN 2/16/26 DPA 5-1-1
Prepared by Senate Research
February 18, 2026
MG/SJ/hk