Mammography Screenings

On May 21, 2018, Gov. Scott signed HB 639 into law. The newly enacted law requires plans to provide coverage for mammography screenings to detect the presence of occult breast cancer. Specifically, plans must provide coverage for annual screening mammograms for female plan participants age 40 and older and screening mammograms for participants younger than age 40 if recommended by participants’ health-care providers. Plans must also provide coverage for screening by ultrasound for plan participants whose screening mammogram results were inconclusive, showed dense breast tissue, or both.

The coverage must meet the following requirements:

  • Coverage must include the full cost of mammography services and can’t be subject to any copayments, coinsurance, cost-sharing requirements or additional charges
  • Coverage applies only to screening procedures conducted by test facilities accredited by the American College of Radiologists
  • Mammography means x-ray examination of breasts using equipment dedicated specifically for mammography, including x-ray tubes, filters, compression devices, screens, filters and cassettes
  • Screenings include mammography test procedures and a qualified physician’s interpretation of procedure results, including additional views and interpretation as needed

The bill is effective for plan years beginning after Jan. 1, 2019. The bill contains no new employer obligations, but employers with fully-insured plans in Vermont should review the new laws to better understand the required coverages.

HB 639 »