Bill Text: CT HB05486 | 2012 | General Assembly | Introduced

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Bill Title: An Act Concerning Health Insurance Coverage For Prescription Drugs And Breast Thermography.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2012-03-09 - Public Hearing 03/15 [HB05486 Detail]

Download: Connecticut-2012-HB05486-Introduced.html

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General Assembly		Raised Bill No. 5486
February Session, 2012		LCO No. 2023
		*02023_______INS*
Referred to Committee on Insurance and Real Estate
Introduced by:
(INS)

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR PRESCRIPTION DRUGS AND BREAST THERMOGRAPHY.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective January 1, 2013) Each insurer, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity that delivers, issues for delivery, renews, amends or continues in this state an individual or a group health insurance policy that provides coverage for prescription drugs shall limit an insured's annual out-of-pocket expenses for prescription drugs, including specialty drugs, to not more than (1) one thousand dollars annually per individual, and (2) two thousand dollars annually per family. The provisions of this section shall not apply to a high deductible plan, as that term is used in subsection (f) of section 38a-493 of the general statutes. As used in this section, "specialty drugs" means prescription drugs that require special handling, administration or monitoring and are used to treat chronic conditions.

Sec. 2. Section 38a-503 of the 2012 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2013):

(a) (1) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide benefits for mammographic examinations to any woman covered under the policy which are at least equal to the following minimum requirements: (A) A baseline mammogram for any woman who is thirty-five to thirty-nine years of age, inclusive; and (B) a mammogram every year for any woman who is forty years of age or older.

(2) Such policy shall provide additional benefits for:

(A) Comprehensive ultrasound screening and [magnetic resonance imaging] thermography, of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if a woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by a woman's physician or advanced practice registered nurse; and

(B) Magnetic resonance imaging of an entire breast or breasts in accordance with guidelines established by the American Cancer Society or the American College of Radiology.

(b) Benefits under this section shall be subject to any policy provisions that apply to other services covered by such policy.

(c) [On and after October 1, 2009, each] Each mammography report provided to a patient shall include information about breast density, based on the Breast Imaging Reporting and Data System established by the American College of Radiology. Where applicable, such report shall include the following notice: "If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening, a breast thermography or a breast MRI examination, or [both] all, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this report.".

Sec. 3. Section 38a-530 of the 2012 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2013):

(a) (1) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide benefits for mammographic examinations to any woman covered under the policy which are at least equal to the following minimum requirements: (A) A baseline mammogram for any woman who is thirty-five to thirty-nine years of age, inclusive; and (B) a mammogram every year for any woman who is forty years of age or older.

(2) Such policy shall provide additional benefits for:

(A) Comprehensive ultrasound screening and [magnetic resonance imaging] thermography, of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if a woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by a woman's physician or advanced practice registered nurse; and

(B) Magnetic resonance imaging of an entire breast or breasts in accordance with guidelines established by the American Cancer Society or the American College of Radiology.

(b) Benefits under this section shall be subject to any policy provisions that apply to other services covered by such policy.

(c) [On and after October 1, 2009, each] Each mammography report provided to a patient shall include information about breast density, based on the Breast Imaging Reporting and Data System established by the American College of Radiology. Where applicable, such report shall include the following notice: "If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening, a breast thermography or a breast MRI examination, or [both] all, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this report.".

This act shall take effect as follows and shall amend the following sections:
Section 1	January 1, 2013	New section
Sec. 2	January 1, 2013	38a-503
Sec. 3	January 1, 2013	38a-530

Statement of Purpose:

To limit an insured's annual out-of-pocket expenses for prescription drugs and to require health insurance coverage for breast thermography.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]