SB 518
Relating to cost-sharing requirements for breast examinations
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Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to ensure that West Virginia residents can receive diagnostic and supplemental breast examinations without facing cost-sharing requirements like deductibles or copays. It prohibits insurance companies from imposing these costs on individuals seeking these screenings, which are medically necessary and clinically appropriate. The bill also allows for existing utilization review processes and permits the Insurance Commissioner to create rules to implement these changes, aligning with professional medical guidelines. It applies to various types of health benefit policies, including those offered by hospitals, medical service corporations, and health maintenance organizations.
Key provisions
- Prohibits cost-sharing requirements (deductibles, coinsurance, copays) for diagnostic and supplemental breast examinations.
- Defines ‘diagnostic breast examinations’ and ‘supplemental breast examinations’ based on medical guidelines.
- Permits existing utilization review processes to continue.
- Addresses potential Health Savings Account ineligibility resulting from the changes.
- Authorizes the Insurance Commissioner to create rules for implementation.
- Applies to coverage issued by various types of insurers (hospital, medical, health maintenance organizations).
- Specifies the effective date of the changes (January 1, 2027, or later).
- Includes provisions related to preventive care and the Internal Revenue Code.
Who is affected
- West Virginia residents
- Insurance companies (health benefit policies)
- Healthcare providers offering breast examinations
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