SB509: SB509 Insurance; certain health benefit policies to cover an annual chest imaging test for a covered person who has undergone a mastectomy or other cancer treatment; provide

26 LC 52 1015 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 Co de of Georgia Annotated,1 relating to general provisions relative to insurance generally, so as to provide for certain2 health benefit policies to cover an annual chest imaging test a nd any additional medically3 necessary chest imaging tests for a covered person who has undergone a mastectomy or other4 cancer treatment; to provide definitions; to provide for relate d matters; to provide for an5 effective date and applicability; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Article 1 of Chapter 24 of Title 33 of the Official Code of Geo rgia Annotated, relating to9 general provisions relative to insurance generally, is amended by revising Code Section10 33-24-59.32, relating to cost-sharing requirements for diagnost ic and supplemental breast11 screening examinations, as follows:12 "33-24-59.32.13 (a) As used in this Code section, the term:14 S. B. 509 - 1 - 26 LC 52 1015 (1) 'Breast magnetic resonance imaging' or 'breast MRI' means a diagnostic and15 screening tool, including standard and abbreviated breast MRI, that uses radio waves and16 magnets to produce detailed images of structures within the breast.17 (2) 'Breast ultrasound' means a noninvasive diagnostic and scr eening tool that uses18 high-frequency sound waves and their echoes to produce detailed images of structures19 within the breast.20 (3) 'Chest imaging test' means a diagnostic and screening tool used to create detailed,21 visual imagery of the chest to diagnose and monitor the absence, presence, or spread of22 a disease, including, but not limited to, cancer. Such term sh all include X-rays,23 ultrasounds, magnetic resonance imaging, positron emission tom ography scans, and24 computed tomography scans of the chest.25 (4) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any26 maximum limitation on the application of such a deductible, coinsurance, copayment, or27 similar out-of-pocket expense.28 (4)(5) 'Diagnostic breast examination' means a medically necessary a nd clinically29 appropriate examination of the breast, including such examinati on using breast MRI,30 breast ultrasound, or mammogram, that is:31 (A) Used to evaluate an abnormality seen or suspected from a screening examination32 for breast cancer; or33 (B) Used to evaluate an abnormality detected by another means of examination.34 (5)(6) 'Health benefit policy' means any individual or group plan, policy, or contract for35 health care healthcare services issued, delivered, issued for delivery, executed, or36 renewed by an insurer in this state, including, but not limited to, those contracts executed37 by the state on behalf of indigents and on behalf of state empl oyees under Article 1 of38 Chapter 18 of Title 45, by a healthcare corporation, health mai ntenance organization,39 preferred provider organization, accident and sickness insurer, fraternal benefit society,40 or other insurer or similar entity. Such term shall not includ e any policy of limited41 S. B. 509 - 2 - 26 LC 52 1015 benefit insurance as defined in paragraph (4) of subsection (e) of Code Section 33-30-12. 42 Such term shall not include any self-insured health benefit plan subject to the exclusive43 jurisdiction of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C.44 Section 1001, et seq.45 (6)(7) 'Insurer' means any person, corporation, or other entity auth orized to provide46 health benefit policies under this title.47 (7)(8) 'Mammogram' means a diagnostic or screening mammography exam using a48 low-dose X-ray to produce an image of the breast.49 (9) 'Mastectomy' means surgical removal of one or both breasts.50 (8)(10) 'Supplemental breast screening examination' means a medically necessary and51 clinically appropriate examination of the breast, including such examination using breast52 MRI, breast ultrasound, or mammogram, that is:53 (A) Used to screen for breast cancer when there is no abnormality seen or suspected54 in the breast; or55 (B) Based on personal or family medical history or additional factors that may increase56 the individual's risk of breast cancer.57 (b) A health benefit policy that provides coverage for diagnostic breast examinations for58 breast cancer shall include provisions that ensure that the cost-sharing req uirements59 applicable to diagnostic breast examinations and supplemental breast screening60 examinations are no less favorable than the cost-sharing requir ements applicable to61 screening mammography for breast cancer.62 (b.1) A health benefit policy that provides coverage for diagn ostic breast examinations63 shall provide coverage for an annual chest imaging test and any additional medically64 necessary and clinically appropriate chest imaging tests for a covered person who has65 undergone a mastectomy or other cancer treatment, such as chemo therapy or radiation66 therapy.67 S. B. 509 - 3 - 26 LC 52 1015 (c) Nothing in this Code section shall be construed to preclude existing utilization review68 provided under Chapter 46 of this title.69 (d) If under federal law application of subsection (b) of this Code section would result in70 Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, such71 cost-sharing requirement shall apply only for Health Savings Ac count qualified High72 Deductible Health Plans with respect to the deductible of such plan after the enrollee has73 satisfied the minimum deductible under Section 223 of the Internal Revenue Code, except74 with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C)75 of the Internal Revenue Code, in which case the requirements of subsection (b) of this76 Code section shall apply regardless of whether the minimum deductible under Section 22377 of the Internal Revenue Code has been satisfied.78 (e) The Commissioner shall promulgate rules and regulations necessary to implement the79 provisions of this Code section in accordance with current guid elines established by80 professional medical organizations such as the National Comprehensive Cancer Network."81 SECTION 2.82 This Act shall become effective on July 1, 2026, and shall apply to all policies or contracts83 issued, delivered, issued for delivery, or renewed in this state on or after such date.84 SECTION 3.85 All laws and parts of laws in conflict with this Act are repealed.86 S. 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