insurance; cost sharing; breast exams

SB 1165 prohibits Arizona health insurance plans (including hospital service corporations and health care service organizations) from charging cost-sharing fees (like deductibles or copays) for diagnostic and supplemental breast exams starting January 1, 2027. Diagnostic exams cover evaluations of abnormalities found during screenings or other tests, while supplemental exams are risk-based screenings for individuals with dense breasts, family history, or other factors. The bill requires insurers to cover these exams without cost-sharing even before a high-deductible plan’s deductible is met, aligning with National Comprehensive Cancer Network guidelines. It directly affects insurance providers and beneficiaries seeking these specific breast cancer screening services.