Bill
HB 5199
Requires Michigan insurers to cover breast cancer screening, lowering eligibility to start at age 35 with one screening every five years for 35–39 and annually from age 40.
Status & procedural history
- Bill number: HB 5199 — amends section 3406d of the Insurance Code (1956 PA 218; MCL 500.3406d).
- Filed March 14, 2025; text reproduced November 4–5, 2025. Introduced/treated in the November reproduction by Rep. Samantha Steckloff. Referred to the House Committee on Insurance (also showing earlier referrals/reads in committee records).
- Next steps (typical): committee consideration and possible hearings, House vote, Senate consideration, and governor’s signature if enacted.
Purpose / intent
- Require health insurers doing business in Michigan to offer or include coverage for breast cancer screening, diagnosis, outpatient treatment, and rehabilitation — and to lower the age threshold for insurer-covered screening mammography to begin at age 35.
Key provisions
1. Coverage requirement (general)
- Insurers that deliver, issue for delivery, or renew health insurance policies in Michigan must offer or include coverage for:
- Breast cancer diagnostic services (e.g., mammography, surgical biopsy, pathology),
- Breast cancer outpatient treatment services (e.g., surgery, radiation, chemotherapy, hormonal therapy, follow-up),
- Breast cancer rehabilitative services (e.g., reconstructive plastic surgery, physical therapy, psychological and social support).
- Coverage is subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those applied for physical illness generally.
Screening mammography — age and frequency
Definitions
Who is affected
- Health insurers issuing or renewing policies in Michigan (individual, group, and possibly other regulated health plans subject to the Insurance Code).
- Women insured under those policies, specifically:
- Women age 35–39 (eligible for one screening in that 5-year span),
- Women age 40 and older (eligible for annual screening).
- Providers of mammography, diagnostic, treatment, and rehabilitative services.
Potential impacts
- Expands access to insurer-covered screening for women beginning at age 35 (though coverage for 35–39 is limited to one exam during a five‑year span).
- May increase utilization of screening services and insurer costs; cost-sharing parity language retains insurers’ existing dollar limits and cost-sharing structures so long as they are not less favorable than for other physical illnesses.
- Implementation and scope will depend on rulemaking, insurer plan designs, and whether the mandate applies uniformly across plan types (e.g., fully insured vs. self-insured ERISA plans).
Limitations / considerations
- The bill does not eliminate deductibles or cost-sharing; it requires parity with coverage for physical illness generally.
- The frequency rule for ages 35–39 is limited (one exam per five years), which may not align with some clinical guidelines recommending different intervals for higher‑risk women.
Compiled from official sources — confirm details with the bill’s official record.
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