Health insurance; cost sharing for breast examinations.
Summary
SB1436 amends Virginia insurance law to prohibit cost sharing for certain breast examinations under most individual and group health insurance policies, subscription contracts, and health maintenance organization plans. The bill covers two categories of exams: diagnostic breast examinations used to evaluate an abnormality found or suspected through screening or other means, and supplemental breast examinations used to screen individuals who are at increased risk based on personal or family history or other factors. The covered exams may include diagnostic mammography, breast MRI, and breast ultrasound, and must be medically necessary and appropriate under National Comprehensive Cancer Network guidelines.
The bill defines cost sharing to include coinsurance, copayments, and deductibles, and it applies to policies and plans delivered, issued for delivery, or renewed in Virginia on and after January 1, 2026. It excludes short-term travel, accident-only, limited or specified disease policies, and short-term nonrenewable policies of six months or less. In effect, the measure expands existing breast cancer screening protections by removing out-of-pocket costs for certain follow-up and higher-risk breast imaging services.
Impact
The bill adds a new section, § 38.2-3418.1:3, to the Code of Virginia and overrides conflicting cost-sharing provisions in existing insurance statutes for the covered breast examinations. It requires insurers, health carriers, and HMOs operating in Virginia to cover these services without deductibles, copays, or coinsurance for applicable plans beginning with policy years or renewals on or after January 1, 2026. The practical impact is to reduce out-of-pocket expenses for patients who need diagnostic or supplemental breast imaging, while shifting those costs to insurers and health plans.
Sentiment
The bill appears to have broad bipartisan support and little visible opposition. It passed the Senate and House overwhelmingly, including unanimous committee reports and near-unanimous floor votes. The voting history suggests the measure was viewed favorably as a breast cancer-related coverage expansion and patient cost-relief bill.
Contention
No major controversy is evident in the available record. The main policy issue is the cost shift to insurers and health plans, which may raise premium or utilization concerns, but no recorded debate or dissent in the provided materials identifies organized opposition. The bill’s use of NCCN guidelines and its focus on medically necessary exams may have helped limit disagreement by narrowing coverage to clinically supported services.