A BILL for an Act to create and enact a new section to chapter 54-52.1 of the North Dakota Century Code, relating to diagnostic breast examination and supplemental breast examination cost-sharing restrictions; to provide for a report to the legislative assembly; to provide for application; and to provide an expiration date.
Summary
HB 1283 would require the health insurance coverage provided by the North Dakota Public Employees Retirement System (PERS) to eliminate deductibles, copayments, coinsurance, and other out-of-pocket cost-sharing for diagnostic breast examinations and supplemental breast examinations. The bill defines those services broadly to include medically necessary breast imaging such as diagnostic mammography, contrast-enhanced mammography, breast MRI, and breast ultrasound when used to evaluate an abnormality or to screen based on elevated risk factors.
The bill also includes a safeguard for qualified high-deductible health plans so that the new cost-sharing restriction would not interfere with federal health savings account eligibility, except for services already treated as preventive care under federal law. The measure would apply to coverage beginning after June 30, 2025, and would expire on June 30, 2027, unless extended. It also directs PERS to prepare a follow-up bill for the 70th Legislative Assembly that would remove the sunset and expand the cost-sharing restriction to all group and individual health insurance policies, accompanied by a report on utilization, costs, and the effect on PERS health programs.
Impact
HB 1283 would amend North Dakota law by creating a new section in chapter 54-52.1 governing PERS health benefits and limiting cost-sharing for certain breast imaging services. In practical terms, it would shift more of the cost of diagnostic and supplemental breast exams from patients to the PERS health plan, while preserving federal high-deductible health plan/HSA rules where necessary. Because the bill is limited to PERS coverage and is temporary, its immediate legal effect would be confined to state employee health benefits rather than the broader commercial insurance market.
Sentiment
The bill appears to have had generally favorable support in the House, where it passed second reading 66-26, but it faced stronger resistance in the Senate, where it narrowly passed one second reading vote 26-19 and then later failed 22-24 on April 11, 2025. That voting pattern suggests the concept of reducing out-of-pocket costs for breast cancer-related imaging had meaningful support, but not enough consensus to survive the full legislative process. No committee transcript was provided, so the available record reflects support and opposition primarily through floor votes rather than detailed debate.
Contention
The main point of contention is likely the cost to the PERS health plan and the precedent of mandating broader insurance coverage without patient cost-sharing. Supporters would view the bill as improving access to medically necessary breast imaging and reducing financial barriers for women at elevated risk or with abnormal findings. Opponents likely focused on premium impacts, plan costs, and whether the state should impose this requirement only on PERS rather than all insurers. The bill’s temporary sunset and required report indicate lawmakers also wanted data before deciding whether to extend the policy statewide.