                                 CODE OF VIRGINIA

COST SHARING FOR BREAST EXAMINATIONS (§ 38.2-3418.1:3)

A. Notwithstanding the provisions of &#xA7; 38.2-3419 or subdivision A 1 of
&#xA7; 38.2-6506, and in addition to the coverage required by &#xA7;
38.2-3418.1, 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 not impose cost sharing for diagnostic breast examinations and
supplemental breast examinations under such policy, contract, or plan delivered,
issued for delivery, or renewed in the Commonwealth.

B. As used in this section:
			&#8220;Cost sharing&#8221; means any coinsurance, copayment, or deductible.
			&#8220;Diagnostic breast examination&#8221; means a medically necessary and
appropriate, in accordance with the National Comprehensive Cancer Network
Guidelines, examination of the breast, including such an examination using
diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound,
that is used to evaluate (i) an abnormality seen or suspected from a screening
for the detection of breast cancer or (ii) an abnormality detected by another
means of examination.
			&#8220;Supplemental breast examination&#8221; means a medically necessary and
appropriate, in accordance with the National Comprehensive Cancer Network
Guidelines, examination of the breast, including such an examination using
diagnostic mammography, 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&#8217;s risk of breast cancer.

C. The provisions of this section shall not apply to short-term travel,
accident-only, or limited or specified disease policies, or to short-term
nonrenewable policies of not more than six months&#8217; duration.

HISTORY: 2025, cc. 485, 496.