Sec. 38a-530. Mandatory coverage for mammography and breast ultrasound.
Sec. 38a-530. Mandatory coverage for mammography and breast ultrasound.
(a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (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. 90-243, S. 114; P.A. 01-171, S. 23; P.A. 05-69, S. 2; P.A. 06-38, S. 2.)
History: P.A. 01-171 added "amended or continued" re policies in this state, substituted "October 1, 2001," for "October
1, 1988," re policy date, and 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; P.A. 05-69 added Subsec. designators
(a) and (b), amended Subsec. (a) to require 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-503 for similar provisions re individual policies.