38.2-3418.1 - Coverage for mammograms.
§ 38.2-3418.1. Coverage for mammograms.
A. 1. Notwithstanding the provisions of § 38.2-3419, each insurer proposingto issue individual or group accident and sickness insurance policiesproviding hospital, medical and surgical or major medical coverage on anexpense incurred basis, each corporation providing individual or groupaccident and sickness subscription contracts and each health maintenanceorganization providing a health care plan for health care services shallprovide coverage under such policy, contract or plan delivered, issued fordelivery or renewed in this Commonwealth on and after July 1, 1996, forlow-dose screening mammograms for determining the presence of occult breastcancer. Such coverage shall make available one screening mammogram to personsage thirty-five through thirty-nine, one such mammogram biennially to personsage forty through forty-nine, one such mammogram annually to persons agefifty and over and may be limited to a benefit of fifty dollars per mammogramsubject to such dollar limits, deductibles and coinsurance factors as are noless favorable than for physical illness generally.
2. The term "mammogram" shall mean an X-ray examination of the breast usingequipment dedicated specifically for mammography, including but not limitedto the X-ray tube, filter, compression device, screens, film and cassettes,with an average radiation exposure of less than one rad mid-breast, two viewsof each breast.
B. In order to be considered a screening mammogram for which coverage shallbe made available under this section:
1. The mammogram must be (i) ordered by a health care practitioner actingwithin the scope of his licensure and, in the case of an enrollee of a healthmaintenance organization, by the health maintenance organization physician,(ii) performed by a registered technologist, (iii) interpreted by a qualifiedradiologist, (iv) performed under the direction of a person licensed topractice medicine and surgery and certified by the American Board ofRadiology or an equivalent examining body and (v) a copy of the mammogramreport must be sent or delivered to the health care practitioner who orderedit;
2. The equipment used to perform the mammogram shall meet the standards setforth by the Virginia Department of Health in its radiation protectionregulations; and
3. The mammography film shall be retained by the radiologic facilityperforming the examination in accordance with the American College ofRadiology guidelines or state law.
C. The provisions of this section shall not apply to short-term travel,accident only, limited or specified disease policies, or to short-termnonrenewable policies of not more than six months' duration.
(1989, c. 646; 1990, c. 284; 1996, c. 610.)