Prohibits an insurance company from imposing any cost-sharing requirements for any diagnostic or supplemental breast examinations.
Summary
H5430 would require health insurance coverage in Rhode Island to eliminate cost-sharing for diagnostic breast examinations and supplemental breast examinations. The bill defines diagnostic exams as medically necessary breast imaging used to evaluate an abnormality found or suspected through screening or another exam, and supplemental exams as medically necessary breast imaging used to screen individuals at increased risk based on personal history, family history, or other risk factors. Covered services include diagnostic mammography, breast MRI, and breast ultrasound.
The bill applies across major categories of private health coverage in the state, including accident and sickness insurance policies, nonprofit hospital service corporations, nonprofit medical service corporations, and health maintenance organizations. If a plan covers these breast examinations, it could not impose deductibles, copayments, coinsurance, or similar out-of-pocket charges for them. The act would take effect on January 1, 2026, and would amend multiple chapters of Rhode Island insurance law to create parallel requirements for different types of insurers and health plans.
Impact
H5430 would change Rhode Island insurance law by adding new sections to four separate chapters governing health coverage, thereby standardizing a no-cost-sharing requirement for diagnostic and supplemental breast exams across most regulated private health plans. It would directly affect insurers, HMOs, nonprofit hospital and medical service corporations, and enrollees who need follow-up or higher-risk breast cancer screening services. The practical effect is to reduce out-of-pocket costs for patients receiving medically necessary breast imaging and to require insurers to cover those services without deductibles, copays, or coinsurance when the plan already provides the benefit.
Sentiment
The bill’s overall sentiment appears strongly supportive of expanded breast cancer screening access and reduced financial barriers to care. The sponsor list suggests broad legislative interest, and the bill’s purpose is framed as consumer protection and preventive health coverage. No committee transcript or vote record is available in the provided materials, so there is no recorded opposition or formal debate to indicate divided sentiment.
Contention
The main policy issue likely to draw attention is the cost impact on insurers and, indirectly, premiums, since the bill mandates first-dollar coverage for potentially expensive imaging services. Another possible point of discussion is the scope of the mandate: it covers both diagnostic exams after an abnormal screening and supplemental exams for higher-risk patients, which may raise questions about medical necessity standards and utilization. However, no specific objections, amendments, or vote splits are included in the available record, so any contention is inferred from the structure of the mandate rather than documented debate.