Senate Bill 509
By: Senators Williams of the 25th, Burns of the 23rd, Dickerson of the 21st, Robertson of
the 29th, Ginn of the 47th and others
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,
relating to general provisions relative to insurance generally, so as to provide for certain
health benefit policies to cover an annual chest imaging test and any additional medically
necessary chest imaging tests for a covered person who has undergone a mastectomy or other
cancer treatment; to provide definitions; to provide for related matters; to provide for an
effective date and applicability; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
general provisions relative to insurance generally, is amended by revising Code Section
33-24-59.32, relating to cost-sharing requirements for diagnostic and supplemental breast
screening examinations, as follows:
"33-24-59.32.
(a) As used in this Code section, the term:
(1) 'Breast <del>magnetic resonance imaging' or 'breast</del> MRI' means a diagnostic and
screening tool, including standard and abbreviated breast MRI, that uses radio waves and
magnets to produce detailed images of structures within the breast.
(2) 'Breast ultrasound' means a noninvasive diagnostic and screening tool that uses
high-frequency sound waves and their echoes to produce detailed images of structures
within the breast.
(3) <ins>'Chest imaging test' means a diagnostic and screening tool used to create detailed,
visual imagery of the chest to diagnose and monitor the absence, presence, or spread of
a disease, including, but not limited to, cancer. Such term shall include X-rays,
ultrasounds, magnetic resonance imaging, positron emission tomography scans, and
computed tomography scans of the chest.
(4)</ins> 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any
maximum limitation on the application of such a deductible, coinsurance, copayment, or
similar out-of-pocket expense.
<del>(4)(5)</del> 'Diagnostic breast examination' means a medically necessary and clinically
appropriate examination of the breast, including such examination using breast MRI,
breast ultrasound, or mammogram, that is:
(A) Used to evaluate an abnormality seen or suspected from a screening examination
for breast cancer; or
(B) Used to evaluate an abnormality detected by another means of examination.
<del>(5)(6)</del> 'Health benefit policy' means any individual or group plan, policy, or contract for
<del>health care</del> <ins>healthcare</ins> services issued, delivered, issued for delivery, executed, or
renewed by an insurer in this state, <ins>including, but not limited to, those contracts executed
by the state on behalf of indigents and on behalf of state employees under Article 1 of
Chapter 18 of Title 45, by a healthcare corporation, health maintenance organization,
preferred provider organization, accident and sickness insurer, fraternal benefit society,
or other insurer or similar entity. Such term shall not include any policy of limited
</ins>
<ins>benefit insurance as defined in paragraph (4) of subsection (e) of Code Section 33-30-12.
Such term shall not include any self-insured health benefit plan subject to the exclusive
jurisdiction of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C.
Section 1001, et seq.
</ins> <del>(6)(7)</del> 'Insurer' means any person, corporation, or other entity authorized to provide
health benefit policies under this title.
<del>(7)(8)</del> 'Mammogram' means a diagnostic or screening mammography exam using a
low-dose X-ray to produce an image of the breast.
<ins>(9) 'Mastectomy' means surgical removal of one or both breasts.
(8)(10)</ins> 'Supplemental breast screening examination' means a medically necessary and
clinically appropriate examination of the breast, including such examination using breast
MRI, breast ultrasound, or mammogram, that is:
(A) Used to screen for breast cancer when there is no abnormality seen or suspected
in the breast; or
(B) Based on personal or family medical history or additional factors that may increase
the individual's risk of breast cancer.
(b) A health benefit policy that provides coverage for diagnostic <ins>breast</ins> examinations <del>for
breast cancer</del> shall include provisions that ensure that the cost-sharing requirements
applicable to diagnostic <ins>breast examinations</ins> and supplemental breast screening
examinations are no less favorable than the cost-sharing requirements applicable to
screening mammography for breast cancer.
<ins>(b.1) A health benefit policy that provides coverage for diagnostic breast examinations
shall provide coverage for an annual chest imaging test and any additional medically
necessary and clinically appropriate chest imaging tests for a covered person who has
undergone a mastectomy or other cancer treatment, such as chemotherapy or radiation
therapy.
</ins>
(c) Nothing in this Code section shall be construed to preclude existing utilization review
provided under Chapter 46 of this title.
(d) If under federal law application of subsection (b) of this Code section would result in
Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, such
cost-sharing requirement shall apply only for Health Savings Account qualified High
Deductible Health Plans with respect to the deductible of such plan after the enrollee has
satisfied the minimum deductible under Section 223 of the Internal Revenue Code, except
with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C)
of the Internal Revenue Code, in which case the requirements of subsection (b) of this
Code section shall apply regardless of whether the minimum deductible under Section 223
of the Internal Revenue Code has been satisfied.
(e) The Commissioner shall promulgate rules and regulations necessary to implement the
provisions of this Code section in accordance with current guidelines established by
professional medical organizations such as the National Comprehensive Cancer Network."
SECTION 2.
This Act shall become effective on July 1, 2026, and shall apply to all policies or contracts
issued, delivered, issued for delivery, or renewed in this state on or after such date.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.