S 1494

Florida Senate - 2026  SB 1494
By Senator Davis
5-01179C-26  20261494__
1A bill to be entitled
2An act relating to insurance coverage for breast
3cancer screening; amending s. 627.6418, F.S.; defining
4terms; requiring that certain health insurance
5policies issued, amended, delivered, or renewed on or
6after a specified date provide specified minimum
7coverage for breast cancer screening and diagnosis;
8specifying that specified health insurance policies
9are subject to certain provisions; revising
10applicability; amending s. 627.6613, F.S.; defining
11terms; requiring that certain health insurance
12policies issued, amended, delivered, or renewed on or
13after a specified date provide specified minimum
14coverage for breast cancer screening and diagnosis;
15specifying that specified health insurance policies
16are subject to certain provisions; amending s.
17627.6699, F.S.; defining terms; requiring that certain
18health benefit plans issued on or after a specified
19date provide specified minimum coverage for breast
20cancer screening and diagnosis; specifying that
21specified health insurance policies are subject to
22certain provisions; providing applicability; providing
23construction; requiring insurers to make certain
24coverage available to the policyholder or contract
25holder without being subject to certain deductible or
26coinsurance provisions; amending s. 641.31095, F.S.;
27defining terms; requiring that certain health
28maintenance contracts issued or renewed on or after a
29specified date provide specified minimum coverage for
30breast cancer screening and diagnosis; specifying that
31specified health insurance policies are subject to
32certain provisions; providing an effective date.
33
34Be It Enacted by the Legislature of the State of Florida:
35
36Section 1. Section 627.6418, Florida Statutes, is amended
37to read:
38627.6418 Coverage for mammograms.—
39(1) As used in this section, the term:
40(a) “BI-RADS” means the American College of Radiology
41Breast Imaging Reporting and Data System.
42(b) “Diagnostic breast examination” means a medically
43necessary imaging examination of the breast, including, but not
44limited to, an examination using diagnostic mammography, breast
45magnetic resonance imaging, or breast ultrasound, which is used
46to evaluate an abnormality that is seen or reasonably suspected
47during a screening examination for breast cancer. For purposes
48of this paragraph, the term “reasonably suspected” means the
49screening examination evidences at least one observable sign of
50a potential abnormality.
51(c)“Increased risk” means, in accordance with the National
52Comprehensive Cancer Network, any one of the following
53categories which enhances the likelihood that a woman may
54develop breast cancer, including:
551. Having a known genetic predisposition or a pedigree
56suggestive of a genetic predisposition for breast cancer.
572. Having a lifetime risk of breast cancer equal to or
58greater than 20 percent as defined by models that include a
59comprehensive family history, including first-, second-, and,
60when relevant to the model, third-degree relatives.
613. Having previously received thoracic radiation between 10
62and 30 years of age.
634. Being 35 years of age or older with a 5-year risk of
64invasive breast cancer equal to or greater than 1.7 percent.
655. Having a lifetime risk equal to or greater than 20
66percent based on a history of atypical ductal hyperplasia,
67lobular carcinoma in situ, or atypical lobular hyperplasia.
686. Having heterogeneously or extremely dense breast tissue
69as defined under the BI-RADS and based on a woman’s most
70recently completed mammogram results.
71(d)“Screening mammogram” means a radiologic examination
72using equipment dedicated specifically for mammography,
73including digital breast tomosynthesis mammography but not
74including any diagnostic mammography imaging, for the purpose of
75detecting any potential breast cancer, which examination results
76in the production of at least two radiographic images of each
77breast.
78(e) “Supplemental breast cancer screening” means an imaging
79examination of the breast, including, but not limited to, breast
80magnetic resonance imaging, breast ultrasound, contrast-enhanced
81mammography, or molecular breast imaging, which is used to
82screen for breast cancer when there is no abnormality seen or
83suspected.
84(2)[(1)] A major medical or similar comprehensive [An accident]
85[or] health insurance policy issued, amended, delivered, or
86renewed in this state on or after January 1, 2027, must provide
87all of the following minimum coveragein accordance with the
88most recent applicable National Comprehensive Cancer Network’s
89Breast Cancer Screening and Diagnosis guidelines [coverage ][for at]
90[least the following]:
91(a) [A baseline mammogram for any woman who is 35 years of]
92[age or older, but younger than 40 years of age.]
93[(b) A mammogram every 2 years for any woman who is 40 years]
94[of age or older, but younger than 50 years of age, or more]
95[frequently based on the patient’s physician’s recommendation.]
96[(c)] A screening mammogram every year for any woman who is
9740 [50] years of age or older.
98(b)[(d)] One or more medically necessary screening mammograms
99a year, based upon a [physician’s] recommendation of a physician
100licensed under chapter 458 or chapter 459, for any woman who is
101at an increased risk of developing [for] breast cancer [because of]
102[a personal or family history of breast cancer, because of having]
103[a history of biopsy-proven benign breast disease, because of]
104[having a mother, sister, or daughter who has or has had breast]
105[cancer, or because a woman has not given birth before the age of]
106[30].
107(c) One medically necessary supplemental breast cancer
108screening a year, based upon a recommendation of a physician
109licensed under chapter 458 or chapter 459, for any woman who is
110at an increased risk of developing breast cancer.
111(3)A major medical or similar comprehensive health
112insurance policy issued for an insured who has dense breast
113tissue by itself in the absence of any evidence of an
114abnormality or suspicious abnormality of the breast as defined
115by BI-RADS is subject to the coverage requirements provided in
116paragraphs (2)(b) and (c).
117(4)Amajor medical or similar comprehensive health
118insurance policy is subject to this section after treatment for
119any breast cancer is completed, even if the insured is in a
120remission and surveillance period prior to any clinical
121designation that the insured is in long-term remission or cured,
122provided any examination conducted during such period does not
123meet the definition of a diagnostic breast examination.
124(5)[(2)] [Except as provided in paragraph (1)(b), for]
125[mammograms done more frequently than every 2 years for women 40]
126[years of age or older but younger than 50 years of age,] The
127coverage required by paragraphs (2)(a) and (b) [subsection (1)]
128applies, with or without a licensed treating physician’s
129[physician] prescription, if the insured obtains a screening
130mammogram in an office, facility, or health testing service that
131uses radiological equipment registered with the Department of
132Health for breast cancer screening. The coverage is subject to
133the deductible and coinsurance provisions applicable to
134outpatient visits, and is also subject to all other terms and
135conditions applicable to other benefits. This section does not
136affect any requirements or prohibitions relating to who may
137perform, analyze, or interpret a screening mammogram or the
138persons to whom the results of a screening mammogram may be
139furnished or released.
140(6)[(3)] This section applies [does not apply] to [disability]
141[income, specified disease, or hospital indemnity] policies
142providing major medical or similar comprehensive coverage or
143benefits.
144(7)[(4)] Every insurer subject to the requirements of this
145section shall make available to the policyholder as part of the
146application, for an appropriate additional premium, the coverage
147required in this section without such coverage being subject to
148the deductible or coinsurance provisions of the policy.
149Section 2. Section 627.6613, Florida Statutes, is amended
150to read:
151627.6613 Coverage for mammograms.—
152(1) As used in this section, the term:
153(a) “BI-RADS” means the American College of Radiology
154Breast Imaging Reporting and Data System.
155(b) “Diagnostic breast examination” means a medically
156necessary imaging examination of the breast, including, but not
157limited to, an examination using diagnostic mammography, breast
158magnetic resonance imaging, or breast ultrasound, which is used
159to evaluate an abnormality that is seen or reasonably suspected
160during a screening examination for breast cancer. For purposes
161of this paragraph, the term “reasonably suspected” means the
162screening examination evidences at least one observable sign of
163a potential abnormality.
164(c)“Increased risk” means, in accordance with the National
165Comprehensive Cancer Network, any one of the following
166categories which enhances the likelihood that a woman may
167develop breast cancer, including:
1681. Having a known genetic predisposition or a pedigree
169suggestive of a genetic predisposition for breast cancer.
1702. Having a lifetime risk of breast cancer equal to or
171greater than 20 percent as defined by models that include a
172comprehensive family history, including first-, second-, and,
173when relevant to the model, third-degree relatives.
1743. Having previously received thoracic radiation between 10
175and 30 years of age.
1764. Being 35 years of age or older with a 5-year risk of
177invasive breast cancer equal to or greater than 1.7 percent.
1785. Having a lifetime risk equal to or greater than 20
179percent based on a history of atypical ductal hyperplasia,
180lobular carcinoma in situ, or atypical lobular hyperplasia.
1816. Having heterogeneously or extremely dense breast tissue
182as defined under the BI-RADS and based on a woman’s most
183recently completed mammogram results.
184(d)“Screening mammogram” means a radiologic examination
185using equipment dedicated specifically for mammography,
186including digital breast tomosynthesis mammography but not
187including any diagnostic mammography imaging, for the purpose of
188detecting any potential breast cancer, which examination results
189in the production of at least two radiographic images of each
190breast.
191(e) “Supplemental breast cancer screening” means an imaging
192examination of the breast, including, but not limited to, breast
193magnetic resonance imaging, breast ultrasound, contrast-enhanced
194mammography, or molecular breast imaging, which is used to
195screen for breast cancer when there is no abnormality seen or
196suspected.
197(2)[(1)] A group, blanket, or franchise major medical or
198similar comprehensive [accident or] health insurance policy
199issued, amended, delivered, or renewed in this state on or after
200January 1, 2027, must provide all of the following minimum
201coverage in accordance with the most recent applicable National
202Comprehensive Cancer Network’s Breast Cancer Screening and
203Diagnosis guidelines [coverage ][for at least the following]:
204(a) [A baseline mammogram for any woman who is 35 years of]
205[age or older, but younger than 40 years of age.]
206[(b) A mammogram every 2 years for any woman who is 40 years]
207[of age or older, but younger than 50 years of age, or more]
208[frequently based on the patient’s physician’s recommendation.]
209[(c)] A screening mammogram every year for any woman who is
21040 [50] years of age or older.
211(b)[(d)] One or more medically necessary screening mammograms
212a year, based upon a [physician’s] recommendation of a physician
213licensed under chapter 458 or chapter 459, for any woman who is
214at an increased risk of developing [for] breast cancer [because of]
215[a personal or family history of breast cancer, because of having]
216[a history of biopsy-proven benign breast disease, because of]
217[having a mother, sister, or daughter who has or has had breast]
218[cancer, or because a woman has not given birth before the age of]
219[30].
220(c) One medically necessary supplemental breast cancer
221screening a year, based upon a recommendation of a physician
222licensed under chapter 458 or chapter 459, for any woman who is
223at an increased risk of developing breast cancer.
224(3)Agroup, blanket, or franchise major medical or similar
225comprehensive health insurance policy issued for an insured who
226has dense breast tissue by itself in the absence of any evidence
227of an abnormality or suspicious abnormality of the breast as
228defined by BI-RADS is subject to the coverage requirements
229provided in paragraphs (2)(b) and (c).
230(4)Agroup, blanket, or franchise major medical or similar
231comprehensive health insurance policy is subject to this section
232after treatment for any breast cancer is completed, even if the
233insured is in a remission and surveillance period prior to any
234clinical designation that the insured is in long-term remission
235or cured, provided any examination conducted during such period
236does not meet the definition of a diagnostic breast examination.
237(5)[(2)] [Except as provided in paragraph (1)(b), for]
238[mammograms done more frequently than every 2 years for women 40]
239[years of age or older but younger than 50 years of age,] The
240coverage required by paragraphs (2)(a) and (b) [subsection (1)]
241applies, with or without a licensed treating physician’s
242[physician] prescription, if the insured obtains a screening
243mammogram in an office, facility, or health testing service that
244uses radiological equipment registered with the Department of
245Health for breast cancer screening. The coverage is subject to
246the deductible and coinsurance provisions applicable to
247outpatient visits, and is also subject to all other terms and
248conditions applicable to other benefits. This section does not
249affect any requirements or prohibitions relating to who may
250perform, analyze, or interpret a screening mammogram or the
251persons to whom the results of a screening mammogram may be
252furnished or released.
253(6)[(3)] Every insurer referred to in subsection (1) shall
254make available to the policyholder as part of the application,
255for an appropriate additional premium, the coverage required in
256this section without such coverage being subject to the
257deductible or coinsurance provisions of the policy.
258Section 3. Present subsection (17) of section 627.6699,
259Florida Statutes, is redesignated as subsection (18), and a new
260subsection (17) is added to that section, to read:
261627.6699 Employee Health Care Access Act.—
262(17) COVERAGE FOR MAMMOGRAMS.—
263(a) As used in this subsection, the term:
2641. “BI-RADS” means the American College of Radiology Breast
265Imaging Reporting and Data System.
2662. “Diagnostic breast examination” means a medically
267necessary imaging examination of the breast, including, but not
268limited to, an examination using diagnostic mammography, breast
269magnetic resonance imaging, or breast ultrasound, which is used
270to evaluate an abnormality that is seen or reasonably suspected
271during a screening examination for breast cancer. For purposes
272of this subparagraph, the term “reasonably suspected” means the
273screening examination evidences at least one observable sign of
274a potential abnormality.
2753.“Increased risk” means, in accordance with the National
276Comprehensive Cancer Network, any one of the following
277categories which enhances the likelihood that a woman may
278develop breast cancer, including:
279a. Having a known genetic predisposition or a pedigree
280suggestive of a genetic predisposition for breast cancer.
281b. Having a lifetime risk of breast cancer equal to or
282greater than 20 percent as defined by models that include a
283comprehensive family history, including first-, second-, and,
284when relevant to the model, third-degree relatives.
285c. Having previously received thoracic radiation between 10
286and 30 years of age.
287d. Being 35 years of age or older with a 5-year risk of
288invasive breast cancer equal to or greater than 1.7 percent.
289e. Having a lifetime risk equal to or greater than 20
290percent based on a history of atypical ductal hyperplasia,
291lobular carcinoma in situ, or atypical lobular hyperplasia.
292f. Having heterogeneously or extremely dense breast tissue
293as defined under the BI-RADS and based on a woman’s most
294recently completed mammogram results.
2954.“Screening mammogram” means a radiologic examination
296using equipment dedicated specifically for mammography,
297including digital breast tomosynthesis mammography but not
298including any diagnostic mammography imaging, for the purpose of
299detecting any potential breast cancer, which examination results
300in the production of at least two radiographic images of each
301breast.
3025.“Supplemental breast cancer screening” means an imaging
303examination of the breast, including, but not limited to, breast
304magnetic resonance imaging, breast ultrasound, contrast-enhanced
305mammography, or molecular breast imaging, which is used to
306screen for breast cancer when there is no abnormality seen or
307suspected.
308(b)A health benefit plan issued in this state on or after
309January 1, 2027, must provide for all of the following minimum
310coverage in accordance with the most recent applicable National
311Comprehensive Cancer Network’s Breast Cancer Screening and
312Diagnosis guidelines:
3131. A screeningmammogram every year for any woman who is 40
314years of age or older.
3152.One or more medically necessary screening mammograms a
316year, based upon a recommendation of a physician licensed under
317chapter 458 or chapter 459, for any woman who is at an increased
318risk of developing breast cancer.
3193. One medically necessary supplemental breast cancer
320screening a year, based upon a recommendation of a physician
321licensed under chapter 458 or chapter 459, for any woman who is
322at an increased risk of developing breast cancer.
323(c) Ahealth benefit plan issued for an insured who has
324dense breast tissue by itself in the absence of any evidence of
325an abnormality or suspicious abnormality of the breast as
326defined by BI-RADS is subject to the coverage requirements
327provided in subparagraphs (b)2. and 3.
328(d) Ahealth benefit plan is subject to this section after
329treatment for any breast cancer is completed, even if the
330insured is in a remission and surveillance period prior to any
331clinical designation that the insured is in long-term remission
332or cured provided any examination conducted during such period
333does not meet the definition of a diagnostic breast examination.
334(e)The coverage required by subparagraphs (b)2. and 3.
335applies, with or without a licensed treating physician’s
336prescription, if the insured obtains a screening mammogram in an
337office, facility, or health testing service that uses
338radiological equipment registered with the Department of Health
339for breast cancer screening. The coverage is subject to the
340deductible and coinsurance provisions applicable to outpatient
341visits and is also subject to all other terms and conditions
342applicable to other benefits. This section does not affect any
343requirements or prohibitions relating to who may perform,
344analyze, or interpret a screening mammogram or the persons to
345whom the results of a screening mammogram may be furnished or
346released.
347(f) This subsection applies to policies providing health
348benefit plan coverage or benefits.
349(g) Every insurer subject to the requirements of this
350subsection shall make available to the policyholder or contract
351holder as part of the application, for an appropriate additional
352premium, the coverage required in this subsection without such
353coverage being subject to the deductible or coinsurance
354provisions of the policy.
355Section 4. Section 641.31095, Florida Statutes, is amended
356to read:
357641.31095 Coverage for mammograms.—
358(1) As used in this section, the term:
359(a) “BI-RADS” means the American College of Radiology
360Breast Imaging Reporting and Data System.
361(b) “Diagnostic breast examination” means a medically
362necessary imaging examination of the breast, including, but not
363limited to, an examination using diagnostic mammography, breast
364magnetic resonance imaging, or breast ultrasound, which is used
365to evaluate an abnormality that is seen or reasonably suspected
366during a screening examination for breast cancer. For purposes
367of this paragraph, the term “reasonably suspected” means the
368screening examination evidences at least one observable sign of
369a potential abnormality.
370(c)“Increased risk” means, in accordance with the National
371Comprehensive Cancer Network, any one of the following
372categories which enhances the likelihood that a woman may
373develop breast cancer, including:
3741. Having a known genetic predisposition or a pedigree
375suggestive of a genetic predisposition for breast cancer.
3762. Having a lifetime risk of breast cancer equal to or
377greater than 20 percent as defined by models that include a
378comprehensive family history, including first-, second-, and,
379when relevant to the model, third-degree relatives.
3803. Having previously received thoracic radiation between 10
381and 30 years of age.
3824. Being 35 years of age or older with a 5-year risk of
383invasive breast cancer equal to or greater than 1.7 percent.
3845. Having a lifetime risk equal to or greater than 20
385percent based on a history of atypical ductal hyperplasia,
386lobular carcinoma in situ, or atypical lobular hyperplasia.
3876. Having heterogeneously or extremely dense breast tissue
388as defined under the BI-RADS and based on a woman’s most
389recently completed mammogram results.
390(d)“Screening mammogram” means a radiologic examination
391using equipment dedicated specifically for mammography,
392including digital breast tomosynthesis mammography but not
393including any diagnostic mammography imaging, for the purpose of
394detecting any potential breast cancer, which examination results
395in the production of at least two radiographic images of each
396breast.
397(e) “Supplemental breast cancer screening” means an imaging
398examination of the breast, including, but not limited to, breast
399magnetic resonance imaging, breast ultrasound, contrast-enhanced
400mammography, or molecular breast imaging, which is used to
401screen for breast cancer when there is no abnormality seen or
402suspected.
403(2)[(1)] Every health maintenance contract issued or renewed
404on or after January 1, 2027 [1996], shall provide for all of the
405following minimum coverage in accordance with the most recent
406applicable National Comprehensive Cancer Network’s Breast Cancer
407Screening and Diagnosis guidelines [coverage ][for at least the]
408[following]:
409(a) [A baseline mammogram for any woman who is 35 years of]
410[age or older, but younger than 40 years of age.]
411[(][b) A mammogram every 2 years for any woman who is 40 years]
412[of age or older, but younger than 50 years of age, or more]
413[frequently based on the patient’s physician’s recommendations.]
414[(c)] A screening mammogram every year for any woman who is
41540 [50] years of age or older.
416(b)[(d)] One or more medically necessary screening mammograms
417and one supplemental breast cancer screening [mammograms] a year,
418based upon a [physician’s] recommendation of a physician licensed
419under chapter 458 or chapter 459, for any woman who is at an
420increased risk of developing [for] breast cancer [because of a]
421[personal or family history of breast cancer, because of having a]
422[history of biopsy-proven benign breast disease, because of]
423[having a mother, sister, or daughter who has had breast cancer,]
424[or because a woman has not given birth before the age of 30].
425(3)A health maintenance contract issued for a member who
426has dense breast tissue by itself in the absence of any evidence
427of an abnormality or suspicious abnormality of the breast as
428defined by BI-RADS is subject to the coverage requirements
429provided in paragraph (2)(b).
430(4)Ahealth maintenance contract is subject to this
431section after treatment for any breast cancer is completed even
432if the member is in a remission and surveillance period prior to
433any clinical designation that the member is in long-term
434remission or cured, provided any examination conducted during
435such period does not meet the definition of a diagnostic breast
436examination.
437(5)[(2)] The coverage required by this section is subject to
438the deductible and copayment provisions applicable to outpatient
439visits, and is also subject to all other terms and conditions
440applicable to other benefits. A health maintenance organization
441shall make available to the subscriber as part of the
442application, for an appropriate additional premium, the coverage
443required in this section without such coverage being subject to
444any deductible or copayment provisions in the contract.
445Section 5. This act shall take effect July 1, 2026.