HB297 would require health insurance coverage parity for supplemental and diagnostic breast imaging in North Carolina. The bill expands and reorganizes existing insurance statutes to require coverage for medically necessary breast cancer diagnostic and supplemental examinations, including breast MRI, breast ultrasound, and diagnostic low-dose mammography, when ordered by a treating healthcare provider. It also preserves existing coverage for cervical cancer screening and low-dose screening mammography, while defining key terms such as cost-sharing, high-deductible health plans, and the types of breast imaging covered.
The bill applies these requirements not only to private health benefit plans but also to the State Health Plan. For covered diagnostic or supplemental breast cancer imaging, any cost-sharing must be no less favorable than the cost-sharing for screening mammography. The bill also limits reimbursement rules for out-of-network providers, stating that insurers are not required to pay more than the contracted-network rate for these services. Separate provisions create billing rules for healthcare providers, prohibiting non-contracted providers from billing patients above the insurer’s reimbursement amount for breast cancer prevention services.
HB297 would amend and recodify portions of Chapter 58 and Chapter 90 of the General Statutes, repeal two existing insurance provisions, and create a new article on transparency in healthcare provider billing practices. It would take effect October 1, 2025, for most insurance changes and services provided on or after that date. The bill therefore affects insurers, the State Health Plan, healthcare providers, and patients seeking breast cancer screening and follow-up imaging.
The general sentiment reflected in the bill text is supportive of expanded access and financial parity for breast cancer imaging, with the policy framed as a preventive-care and affordability measure. No committee transcript or recorded votes were provided, so there is no direct evidence of debate or opposition in the supplied materials. Based on the structure of the bill, likely points of discussion would include insurer cost exposure, provider billing restrictions, and how the parity rules interact with high-deductible health plans and out-of-network reimbursement.
HB297 would revise North Carolina insurance law by recodifying G.S. 58-51-57 as G.S. 58-3-271, repealing related provisions in Chapters 58 and 67, and extending parity requirements to the State Health Plan. It would require coverage and comparable cost-sharing for diagnostic and supplemental breast cancer imaging, while also adding new billing restrictions in Chapter 90 that limit what non-contracted providers may charge patients for covered breast cancer prevention services. The bill would affect insurers, the State Health Plan, healthcare providers, and insured patients beginning October 1, 2025.
The bill appears generally favorable and consumer-protective, with its stated purpose focused on breast cancer prevention, early detection, and reducing financial barriers to medically necessary imaging. Because no committee discussion transcripts or votes were provided, there is no documented opposition or support to characterize beyond the bill’s text. The available context suggests a policy consensus-oriented measure aimed at improving access to care rather than a highly partisan proposal.
The main likely points of contention are cost and reimbursement. Insurers may object to expanded coverage and parity requirements for MRI and ultrasound, while providers may be affected by the bill’s limits on billing patients and reimbursement rules for out-of-network services. Another possible issue is how the mandate applies to high-deductible health plans and whether the parity requirements could increase premiums or administrative complexity. No specific objections were recorded in the supplied committee or vote history.