Rules on Mammography Coverage Amended

On March 27, 2017, Gov. Hutchinson signed H.B. 2022 into law, creating Act 708. This law amends the Arkansas Insurance code concerning the coverage of mammograms for female plan participants. Beginning July 20, 2017, insurance carriers must offer to provide coverage for mammography screening for breast cancer. This includes screening mammography (including digital breast tomosynthesis) and breast ultrasounds for purposes of early detection of breast cancer. If plans choose to provide this coverage, then the plan must allow one baseline mammogram for participants age 35-40, one mammogram every other year for participants age 40-49, annual mammograms for participants age 50 and older, and mammograms at any age when recommended by doctors for patients with a family history of breast cancer.

Plans must also provide coverage for comprehensive screenings of the breasts if mammography indicates heterogeneous or extremely dense breast tissue and participants’ doctors determine comprehensive ultrasound screenings are medically necessary. The law also prohibits insurers from charging copayments or deductibles to screening mammography. While insurers may apply copayments to breast ultrasounds, they may not apply deductibles to them.

This law ultimately applies to insurers. However, employers should familiarize themselves with this law so that they remain up to date as to how mammography benefits will be covered.

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