A bill for an act relating to cost-sharing requirements for supplemental and diagnostic breast examinations.(See HF 318.)
Summary
HSB100 would amend Iowa insurance law to regulate cost-sharing for supplemental and diagnostic breast examinations. The bill defines “cost-sharing” broadly to include copayments, coinsurance, deductibles, coverage limits, and other out-of-pocket obligations, and then requires that any cost-sharing imposed for these breast exams be no less favorable than the cost-sharing applied to screening mammograms.
The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in Iowa on or after January 1, 2026. In practical terms, it would extend existing breast cancer-related coverage protections by limiting how much insurers can charge patients for follow-up or diagnostic breast imaging when such services are required under section 514C.4A.
Impact
HSB100 would amend section 514C.4A of the Iowa Code to add a new cost-sharing standard for supplemental and diagnostic breast examinations. It would affect health carriers and other third-party payment plans by prohibiting them from imposing less favorable patient cost-sharing for these exams than they use for screening mammograms. The bill would therefore reduce out-of-pocket costs for covered patients needing additional breast imaging and would likely require insurers to align benefit design and claims processing with the new parity requirement for policies renewed or issued on or after January 1, 2026.
Sentiment
The available legislative history suggests the bill was received favorably, at least at the committee stage. The House Committee on Commerce reported the bill with a unanimous 23-0 vote, and there are no recorded committee transcript objections in the provided materials. The absence of recorded opposition and the strong committee vote indicate broad support for the measure.
Contention
No specific points of contention are documented in the provided transcripts, but the bill’s main policy issue is the extent to which insurers may charge cost-sharing for supplemental and diagnostic breast examinations. Any debate would likely center on patient affordability and access to follow-up breast imaging versus insurer concerns about mandated benefit design and potential cost impacts. The bill’s requirement that cost-sharing be no less favorable than for screening mammograms is the key standard that could draw scrutiny from carriers or employers sponsoring health plans.