Section 21.42.375 - [Effective 1/1/2025] Coverage for mammograms(a) Except for a fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan shall provide coverage for low-dose mammography screening under the schedule described in (b) of this section if the plan covers mastectomies and prosthetic devices and reconstructive surgery incident to mastectomies.(b) The minimum coverage required under (a) of this section includes (1) a baseline mammogram for a covered individual who is at least 35 years of age but less than 40 years of age;(2) one mammogram every two years for a covered individual who is at least 40 years of age but less than 50 years of age;(3) an annual mammogram for a covered individual who is at least 50 years of age;(4) a mammogram at any age for a covered individual with a history of breast cancer or whose parent or sibling has a history of breast cancer, upon referral by a physician.(c) The coverage required by this section (1) must be included in the health care insurance plan on a basis that is not less favorable than for other radiological examinations;(2) may be subject to standard policy provisions applicable to other benefits, such as deductible or copayment provisions.(d)[Repealed, Sec. 115 ch 81 SLA 1997].(e) In this section,(1) "diagnostic breast examination" means an examination of the breast using contrast-enhanced mammography, diagnostic mammography, breast magnetic resonance imaging, breast ultrasound, or other equipment dedicated specifically for mammography conducted to evaluate an abnormality(A) detected or suspected in a screening examination for breast cancer; or(B) detected by another means of examination;(2) "low-dose mammography screening" and "mammogram" mean the X-ray examination of the breast using equipment dedicated specifically for mammography, including the X-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast;(3) "supplemental breast examination" means an examination of the breast using contrast-enhanced mammography, diagnostic mammography, breast magnetic resonance imaging, breast ultrasound, or other equipment dedicated specifically for mammography conducted based on (A) the insured's personal or family medical history of breast cancer; or(B) other factors that may increase the insured's risk of breast cancer.(f) Except as necessary to qualify a plan as a high deductible health plan eligible for a health savings account tax deduction under 26 U.S.C. 223 (Internal Revenue Code), a health care insurer that offers, issues, delivers, or renews a health care insurance plan in the individual or group market in the state that provides coverage for mammography screening, diagnostic breast examinations, and supplemental breast examinations may not impose cost sharing, a deductible, coinsurance, a copayment obligation, or another similar out-of-pocket expense on an insured for coverage of a low-dose mammography screening, diagnostic breast examination, or supplemental breast examination.Amended by SLA 2024, ch. 39,sec. 3, eff. 1/1/2025, app. to an insurance policy or contract issued, delivered, or renewed on or after 1/1/2025.Amended by SLA 2024, ch. 39,sec. 2, eff. 1/1/2025, app. to an insurance policy or contract issued, delivered, or renewed on or after 1/1/2025.This section is set out more than once due to postponed, multiple, or conflicting amendments.