HB598 would prohibit insurers, health maintenance organizations, and hospital or medical service plans in Hawaii from imposing cost-sharing on covered breast cancer screening, supplemental breast examinations, and diagnostic breast examinations. The bill defines cost-sharing broadly to include deductibles, copayments, coinsurance, and similar out-of-pocket limits. It also defines supplemental breast examinations as medically necessary screening based on personal or family history or other risk factors, and diagnostic breast examinations as medically necessary follow-up exams for abnormalities found through screening or other means.
The bill applies to three insurance frameworks in Hawaii’s statutes: accident and health or sickness insurance policies, hospital or medical service plan contracts, and HMO policies, contracts, plans, or agreements. It also amends existing mammography coverage provisions to make clear that the new no-cost-sharing rule controls where applicable, while preserving a narrow exception for high deductible health plans so that coverage does not interfere with federal tax-advantaged HSA eligibility under Internal Revenue Code section 223. The measure would take effect January 1, 2026, and apply to plans issued or renewed on or after that date.
Impact
HB598 would add new insurance coverage mandates to chapters 431, 432, and 432D of the Hawaii Revised Statutes, requiring specified breast cancer-related imaging and examinations to be covered without patient cost-sharing, subject to the high-deductible health plan exception. It would also amend existing statutory language in the mammography coverage provisions to carve out the new no-cost-sharing rule. In practical terms, insurers, mutual benefit societies, HMOs, and similar health plans would need to adjust benefit designs and claims processing for breast MRI, breast ultrasound, and related diagnostic or supplemental breast exams when those services are covered.
Sentiment
Based on the bill text and available context, the measure appears to have a generally supportive public-health orientation, with a clear consumer-protection focus on reducing financial barriers to breast cancer detection and follow-up care. The bill’s structure suggests an intent to align coverage with medically necessary screening and diagnostic practices, especially for higher-risk patients. No committee transcripts or recorded votes were provided, so there is no documented opposition or formal sentiment from hearings in the supplied materials.
Contention
The main policy tension in HB598 is between expanding access to breast cancer-related imaging without out-of-pocket costs and preserving the federal tax treatment of high deductible health plans. The bill addresses that concern by allowing minimal cost-sharing only to the extent necessary to maintain HSA eligibility. Another possible point of contention is the cost to insurers and potential premium impacts from mandating first-dollar coverage for supplemental MRI and ultrasound screening, especially for individuals with elevated breast cancer risk. No specific objections, amendments, or stakeholder disputes are included in the provided record.