Bill Sponsors
Zurier, Sosnowski, Murray, Tikoian, Urso, Lauria, Thompson, Valverde, Ujifusa, and Appollonio
Committee
Senate Health & Human Services
Summary
Select
This legislation mandates that various types of health insurance plans in Rhode Island provide coverage for diagnostic and supplemental breast examinations without imposing any cost-sharing requirements on the patient. This applies to diagnostic mammography, breast magnetic resonance imaging (MRI), and breast ultrasounds used to evaluate abnormalities or screen individuals based on personal or family medical history. The bill amends laws governing accident and sickness policies, nonprofit hospital and medical service corporations, and health maintenance organizations to ensure these specific examinations are free of deductibles, copayments, or coinsurance for the insured individual.
Sponsor
Analysis
Pros for Progressives
- Eliminates out-of-pocket costs for essential preventative and diagnostic care, ensuring that low-income individuals are not deterred from seeking medical attention due to financial barriers.
- Promotes health equity and social justice by expanding access to women's healthcare services, potentially reducing disparities in cancer survival rates among disadvantaged communities.
- Strengthens the social safety net by protecting patients from surprise medical bills and debt associated with necessary diagnostic procedures.
Cons for Progressives
- Relies on and reinforces the private, for-profit insurance industry structure rather than moving toward a systemic reform like a single-payer public healthcare system.
- May lead insurance companies to raise premiums across the board to offset the costs, which could disproportionately impact lower-income individuals who pay for their own plans.
- Focuses solely on diagnostic and screening costs without addressing the potentially prohibitive costs of treatment if cancer is actually detected.
Pros for Conservatives
- Encourages early detection of serious illness, which can prevent more expensive catastrophic medical interventions later, aligning with long-term fiscal responsibility.
- Supports the health and well-being of mothers and women, aligning with traditional social values regarding the preservation of the family unit.
- Maintains the provision of services through the private sector rather than creating a new government-run healthcare facility or bureaucracy.
Cons for Conservatives
- Imposes strict government mandates on private corporations, violating principles of corporate freedom and free market enterprise.
- Interferes with the freedom of contract between insurers and policyholders by dictating specific plan terms and banning cost-sharing arrangements.
- Likely results in increased insurance premiums for all policyholders, effectively redistributing costs and increasing the financial burden on the general public.
Constitutional Concerns
None Likely
Impact Overview
Groups Affected
- Women
- Health Insurance Companies
- Patients with family history of breast cancer
- Radiologists
- Employers offering health plans
Towns Affected
All
Cost to Taxpayers
Amount unknown
Revenue Generated
None
BillBuddy Impact Ratings
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Freedom Impact
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Public Services
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Regulatory
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Clarity of Bill Language
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Environmental Impact
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Privacy Impact
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Bill Status
Current Status
Held
Comm Passed
Floor Passed
Law
History
• 01/09/2026 Introduced, referred to Senate Health and Human Services
Bill Text
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section:
27-18-42.1. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section:
27-19-34.2. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section:
27-20-17.2. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense. LC003440 - Page 2 of 5
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:
27-41-30.2. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the LC003440 - Page 3 of 5 individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 5. This act shall take effect on January 1, 2027.
27-18-42.1. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section:
27-19-34.2. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section:
27-20-17.2. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense. LC003440 - Page 2 of 5
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:
27-41-30.2. Diagnostic and supplemental breast examination.
(a) As used in this section, the following words shall have the following meanings:
(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(ii) Used to evaluate an abnormality detected by another means of examination.
(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(ii) Based on personal or family medical history, or additional factors that may increase the LC003440 - Page 3 of 5 individual’s risk of breast cancer.
(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.
SECTION 5. This act shall take effect on January 1, 2027.