Prohibits an insurance company from imposing any cost-sharing requirements for any diagnostic or supplemental breast examinations.
Summary
S0197 would require health insurance coverage in Rhode Island to eliminate cost-sharing for diagnostic and supplemental breast examinations. The bill defines diagnostic breast examinations as medically necessary follow-up imaging or evaluation, including diagnostic mammography, breast MRI, or breast ultrasound, used to assess an abnormality found on a screening exam or detected by another means. It defines supplemental breast examinations as medically necessary breast imaging used to screen for cancer in individuals with elevated risk based on personal or family history or other risk factors.
The bill applies this no-cost-sharing requirement across several categories of coverage: accident and sickness insurance policies, nonprofit hospital service corporations, nonprofit medical service corporations, and health maintenance organizations. If a plan already covers screening, supplemental, or diagnostic breast examinations, it could not impose deductibles, copayments, coinsurance, or similar out-of-pocket charges for those services. The act would take effect on January 1, 2026.
Impact
The bill would amend multiple chapters of the Rhode Island General Laws governing health insurance and managed care to bar cost-sharing for diagnostic and supplemental breast examinations when those services are covered benefits. This would affect insurers, nonprofit health service corporations, HMOs, and enrollees in both group and individual coverage, shifting the cost of these breast imaging services from patients to health plans. The measure does not mandate coverage where none exists, but it removes out-of-pocket expenses for covered exams.
Sentiment
Based on the bill text and the absence of recorded committee testimony or votes, the measure appears to be a straightforward consumer- and patient-protection proposal focused on breast cancer detection and early diagnosis. The caption and structure suggest a policy goal of improving access to medically necessary imaging by reducing financial barriers. No formal opposition or support is documented in the provided materials, so the overall sentiment cannot be measured from debate history, but the bill is framed in a broadly favorable public-health context.
Contention
No specific points of contention are recorded in the provided committee transcripts or voting history. Potential areas of debate, based on the bill’s design, could include the cost impact on insurers and premiums, whether the mandate should apply to all plan types, and how broadly “supplemental” and “diagnostic” breast examinations should be interpreted. However, the available record does not identify any legislators, insurers, or advocates taking opposing positions.