Sec. 38a-503. (Formerly Sec. 38-174gg). Mandatory coverage for mammography and breast ultrasound.
Sec. 38a-503. (Formerly Sec. 38-174gg). Mandatory coverage for mammography and breast ultrasound. (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section
38a-469 delivered, issued for delivery, renewed, amended or continued in this state on
or after October 1, 2001, shall provide benefits for mammographic examinations to any
woman covered under the policy which are at least equal to the following minimum
requirements: (1) A baseline mammogram for any woman who is thirty-five to thirty-nine years of age, inclusive; and (2) a mammogram every year for any woman who is
forty years of age or older. Such policy shall provide additional benefits for comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data
System established by the American College of Radiology or if a woman is believed to
be at increased risk for breast cancer due to family history or prior personal history of
breast cancer, positive genetic testing or other indications as determined by a woman's
physician or advanced practice registered nurse.
(b) Benefits under this section shall be subject to any policy provisions that apply
to other services covered by such policy.
(P.A. 88-124, S. 1; P.A. 90-243, S. 93; P.A. 01-171, S. 22; P.A. 05-69, S. 1; P.A. 06-38, S. 1.)
History: P.A. 90-243 substituted reference to health insurance policies for references to hospital or medical expense
policies and contracts and specified applicability solely to individual policies; Sec. 38-174gg transferred to Sec. 38a-503
in 1991; P.A. 01-171 added "amended or continued" re policies in this state, substituted "October 1, 2001," for "October
1, 1988," re policy date, consolidated Subdivs. (2) and (3) to provide annual coverage for any woman who is forty or over
rather than coverage every two years for women 40 to 49 and annually thereafter, and substituted "each" for "every"; P.A.
05-69 added Subsec. designators (a) and (b), amended Subsec. (a) to require benefits for comprehensive ultrasound screening for certain women if recommended by a physician, and made technical changes in Subsec. (b); P.A. 06-38 amended
Subsec. (a) to require policy to provide additional benefits for comprehensive ultrasound screening of an entire breast or
breasts if mammogram demonstrates heterogeneous or dense breast tissue based on the BIRAD System or if a woman is
believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive
genetic testing or other indications determined by a physician or advanced practice registered nurse, eliminating reference
to screening recommended by a physician for a woman classified as a category 2, 3, 4 or 5 under such system.
See Sec. 38a-530 for similar provisions re group policies.