58-18-36 Grandfathered plans required to cover low-dose mammography--Extent of coverage.
Grandfathered plans required to cover low-dose mammography--Extent of
Each group health insurance policy that covers a female and that is delivered, issued for
delivery, or renewed in this state, except for a policy that provides coverage for specified disease or
other limited benefit coverage, shall provide coverage for screening by low-dose mammography for
the presence of occult breast cancer that is subject to the same dollar limits, deductibles and
coinsurance factors as for other radiological examinations. Coverage for the screening shall be
provided as follows: ages thirty-five to thirty-nine, one baseline mammography; ages forty to forty-nine, a mammography every other year; and age fifty and older, a mammography every year.
As used in this section, "low-dose mammography" means the X ray examination of the breast
using equipment dedicated specifically for mammography, including the X ray tube, filter,
compression device, screens, films, and cassettes, with an average radiation exposure delivery of less
than one rad midbreast, with two views for each breast and with interpretation by a qualified
The provisions of this section apply only to grandfathered plans pursuant to 75 Fed. Reg. 116
(2010) to be codified at 26 C.F.R. §§ 54 and 602, 29 C.F.R. § 2590, and 45 C.F.R. § 147. (SL 2011,
ch 216, § 19 provides: "The provisions of this Act are repealed if the Patient Protection and
Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and
Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be
unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all
appeals exhausted or time for appeals elapsed.")
Source: SL 1990, ch 397, §§ 1, 4; SL 1991, ch 400, § 4; SL 2011, ch 216, § 9.