HB 314, titled the Breast Cancer Prevention Modifications bill, amends Utah insurance law to limit out-of-pocket costs for certain breast examinations used to detect breast cancer. It defines several terms, including “cost-sharing requirement,” “breast examination,” “diagnostic breast examination,” and “supplemental breast examination,” and specifically includes contrast-enhanced mammography, diagnostic mammography, breast MRI, and breast ultrasound within the definition of breast examination.
The bill prohibits a health benefit plan from imposing copayments, coinsurance, deductibles, or annual out-of-pocket limits on diagnostic breast examinations and supplemental breast examinations when those services are medically necessary. It also states that these examinations are medically necessary if provided in accordance with National Comprehensive Cancer Network Guidelines. The bill contains no appropriation and is scheduled to take effect on May 7, 2025.
Impact
The bill would enact a new section of Utah Code, Section 31A-22-630.1, within the insurance code, directly affecting health benefit plans offered in the state. It would require insurers to cover qualifying diagnostic and supplemental breast exams without cost-sharing, which could reduce financial barriers for patients undergoing follow-up testing or higher-risk screening and shift more of the cost burden to insurers and plan sponsors.
Sentiment
The available voting history suggests generally favorable committee support, with the House committee vote recorded at 10 yeas and 3 nays before the bill was held. Although there are no committee transcripts provided, the vote indicates that a majority of committee members supported the bill’s consumer-protection and breast cancer screening goals, while a minority opposed or had reservations.
Contention
The main point of contention appears to be whether insurers should be barred from charging any cost-sharing for these exams, since the bill would eliminate copays, deductibles, and other out-of-pocket charges for a defined set of breast cancer-related services. Likely concerns include increased insurance costs, the scope of what qualifies as a supplemental or diagnostic exam, and reliance on NCCN guidelines to determine medical necessity. The 10-3 committee vote shows that while the bill had substantial support, it also faced meaningful opposition.