S.Amdt. 3675

This amendment, submitted by Mrs. Britt and Mrs. Shaheen, aims to add a new section to the Public Health Service Act to ensure that diagnostic and supplemental breast examinations are covered without cost-sharing requirements.

Key Changes and Purposes:

• Eliminating Out-of-Pocket Costs: It prohibits group health plans and health insurance issuers from imposing cost-sharing requirements, such as deductibles, coinsurance, and copayments, for these specific breast examinations.

• Defining Covered Examinations:

  • Diagnostic breast examinations are those used to evaluate an abnormality seen or suspected from a screening or detected by other means.
  • Supplemental breast examinations are used for screening when no abnormality is seen, based on factors like family medical history or personal risk.

• Maintaining Controls: The amendment does not stop health plans from requiring timely prior authorization or other utilization controls. It also does not replace State laws that offer more protection.

• Broad Application: The changes apply to grandfathered health plans and provide a safe harbor for high deductible health plans with health savings account eligibility.

• Timeline: These requirements would apply to plan years beginning on or after January 1, 2026.