Repeals GS 58-65-92 (hospital or medical service plans required to cover mammograms and cervical cancer screening). Repeals GS 58-67-76 (health care maintenance organization health care plans required to cover mammograms and cervical cancer screening).
Recodifies GS 58-51-57 as GS 58-3-271. Amends GS 58-3-271 (concerning health benefit plan coverage for diagnostic, screening, and supplemental exams for breast and cervical cancer) to do the following. Defines cost sharing and high-deductible health plan and defines various diagnostic techniques for cervical and breast cancer. Requires every health benefit plan offered by an insurer that provides benefits for a diagnostic or supplemental exam for breast cancer to ensure that the cost-sharing requirements that apply to the exam are no less favorable than the cost-sharing that applies low-dose screen mammography for breast cancer. Specifies that an insurer is not required to reimburse a healthcare provider that is not a contracted provider in the provider network of a health benefit plan offered by the insurer any reimbursement rate more that the rate paid to a provider that has contracted to participate in-network for the following services: (1) diagnostic, screening, or supplemental examination for breast cancer; (2) low-dose mammography; (3) breast ultrasound; and (4) breast magnetic resonance imaging. Amends the coverage requirements for low-dose screen mammography so that it applies to all individuals, not just women. Sets out provisions governing the applicability of the statue when the application of this statute would render the insured individual ineligible for the specified health savings account. Amends GS 135-48.51 to make GS 58-3-271 applicable to the State Health Plan. Effective October 1, 2025, and applies to insurance contracts issued, renewed, or amended on or after that date.
Recodifies GS 90-701 as GS 90-705. Changes the title of Article 41 of GS Chapter 90 to Transparency in Healthcare Provider Billing Practices and adds the following new statutes. Enacts new GS 90-702, setting out applicable definitions, including defining the terms health benefit plan and healthcare provider. Enacts new GS 90-704 requiring a healthcare provider who has not contracted with an insurer to participate in-network of a health benefit plan to accept as reimbursement for any breast cancer prevention service given to an insured person the amount of reimbursement provided by that insurer, including any cost-sharing required to be paid by the patient; prohibits healthcare providers from billing an insured patient or requesting additional reimbursement from the insurer for any amount above the amount required to be accepted. Effective October 1, 2025, and applies to services provided on or after that date.
Bill Summaries: H297 (2025-2026 Session)
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Bill H 297 (2025-2026)Summary date: Mar 5 2025 - View summary