45-18-4.1. Required coverage for breast cancer screening for individuals with high risk.

As used in this Code section, the term “individual with a high risk for breast cancer” means an individual:#

1. (1)

   With a lifetime risk of breast cancer of 20 percent or greater as according to a risk assessment tool based primarily on family history, such as but not limited to, the Tyrer-Cuzick Version 8.0b model;#

2. (2)

   With a known BRCA1 or BRCA2 gene mutation based on genetic testing;#

3. (3)

   Who has not had genetic testing, but has a first-degree relative with a BRCA1 or BRCA2 gene mutation;#

4. (4)

   Who has had radiation therapy to the chest between ten and 30 years of age; and#

5. (5)

   Who has Li-Fraumeni syndrome, Cowden syndrome, or Ban-nayan-Riley-Ruvalcaba syndrome or has a first-degree relative who has any such syndrome.#

The health insurance plan established pursuant to this article shall include coverage for breast cancer screening for individuals with a high risk for breast cancer who are 30 years of age or older. Such breast cancer screening coverage shall include:#

1. (1)

   An annual mammogram or digital breast tomosynthesis; and#

2. (2)

   An annual breast magnetic resonance imaging (MRI) scan or appropriate alternative advanced screening study, such as but not limited to, whole breast ultrasound, if the individual is unable to undergo such breast magnetic resonance imaging (MRI).#

The department shall collect nonidentifying data on the number of individuals in the health insurance plan established pursuant to this article who are determined to be individuals with a high risk for breast cancer pursuant to this Code section.#