                                 CODE OF VIRGINIA

COVERAGE FOR MAMMOGRAMS (§ 38.2-3418.1)

A. 1. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to
issue individual or group accident and sickness insurance policies providing
hospital, medical and surgical or major medical coverage on an expense incurred
basis, each corporation providing individual or group accident and sickness
subscription contracts and each health maintenance organization providing a
health care plan for health care services shall provide coverage under such
policy, contract or plan delivered, issued for delivery or renewed in this
Commonwealth on and after July 1, 1996, for low-dose screening mammograms for
determining the presence of occult breast cancer. Such coverage shall make
available one screening mammogram to persons age thirty-five through
thirty-nine, one such mammogram biennially to persons age forty through
forty-nine, one such mammogram annually to persons age fifty and over and may be
limited to a benefit of fifty dollars per mammogram subject to such dollar
limits, deductibles and coinsurance factors as are no less favorable than for
physical illness generally.

   2. The term &#8220;mammogram&#8221; shall mean an X-ray examination of the
   breast using equipment dedicated specifically for mammography, including but
   not limited to the X-ray tube, filter, compression device, screens, film and
   cassettes, with an average radiation exposure of less than one rad mid-breast,
   two views of each breast.

B. In order to be considered a screening mammogram for which coverage shall be
made available under this section:

   1. The mammogram must be (i) ordered by a health care practitioner acting
   within the scope of his licensure and, in the case of an enrollee of a health
   maintenance organization, by the health maintenance organization physician,
   (ii) performed by a registered technologist, (iii) interpreted by a qualified
   radiologist, (iv) performed under the direction of a person licensed to
   practice medicine and surgery and certified by the American Board of Radiology
   or an equivalent examining body and (v) a copy of the mammogram report must be
   sent or delivered to the health care practitioner who ordered it;

   2. The equipment used to perform the mammogram shall meet the standards set
   forth by the Virginia Department of Health in its radiation protection
   regulations; and

   3. The mammography film shall be retained by the radiologic facility
   performing the examination in accordance with the American College of
   Radiology 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-term nonrenewable
policies of not more than six months&#8217; duration.

HISTORY: 1989, c. 646; 1990, c. 284; 1996, c. 610.