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H 3202

Diagnostic and supplemental breast examination insurance

2025-2026 Regular Session Introduced by Heather Bauer and 15 co-sponsors

South Carolina health plans must cover diagnostic and supplemental breast exams with no cost-sharing, removing out-of-pocket barriers to follow-up imaging.

Member(s) request name added as sponsor: Henderson-Myers, Grant
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Bill Summary · H 3202

Summary — H 3202: Diagnostic and Supplemental Breast Examination Insurance

Note: The bill text provided contains an unrelated Massachusetts sales‑tax proposal; the operative health‑insurance language below amends the South Carolina Code (adds S.C. Code § 38‑71‑148) and is the focus of this summary.

Main purpose

Require health insurance policies in South Carolina to cover medically appropriate diagnostic and supplemental breast examinations without imposing cost‑sharing (deductibles, coinsurance, copayments, or similar out‑of‑pocket limits), thereby reducing financial barriers to follow‑up and enhanced breast imaging.

Key provisions

  • Adds Section 38‑71‑148 to the South Carolina Code.
  • Definitions:
    • “Cost‑sharing requirements”: deductibles, coinsurance, copayments, and any maximum on those amounts.
    • “Diagnostic breast examinations”: medically necessary exams (per National Comprehensive Cancer Network Guidelines) to evaluate an abnormality detected or suspected on screening — may include contrast‑enhanced mammography, diagnostic mammography, breast MRI, breast ultrasound, or molecular breast imaging.
    • “Supplemental breast examination”: medically necessary exams (per NCCN Guidelines) used to screen for breast cancer when no abnormality is seen but additional risk factors exist (e.g., personal/family history, heterogeneously or extremely dense breasts), using the modalities listed above.
    • “Health insurance policy”: defined to include health benefit plans/contracts as already defined in state statutes.
  • Coverage rule: Health insurance policies may not impose any cost‑sharing requirements on diagnostic and supplemental breast examinations furnished to enrollees.
  • HSA/HDHP exception: To avoid causing Health Savings Account (HSA) ineligibility under IRC §223, the prohibition on cost‑sharing applies to HSA‑qualified high‑deductible health plans (HDHPs) only with respect to the plan deductible after the enrollee has satisfied the federal minimum deductible — except preventive services under IRC §223(c)(2)(C), for which the no cost‑sharing rule applies regardless of whether the federal minimum deductible has been met.
  • Relationship to existing law: These provisions are stated to be in addition to existing coverage requirements under S.C. Code § 38‑71‑145 (current mammography coverage rules).
  • Effective date: Upon approval by the Governor.

Who is affected

  • Insurers and health plan issuers operating in South Carolina (group and individual market plans covered by the state code definitions).
  • Employers and plan sponsors that offer HSA‑qualified HDHPs (due to the federal law interaction).
  • Patients/enrollees who require diagnostic follow‑up or supplemental breast imaging — particularly those with dense breasts, a family/personal history of breast cancer, or an abnormal screening result.

Potential impacts

  • Clinical access: Likely to increase access to recommended follow‑up and supplemental imaging by removing out‑of‑pocket cost barriers.
  • Financial: Insurers may experience higher utilization and costs for advanced imaging; those costs could be reflected in premiums over time. The HSA/HDHP exception seeks to limit conflicts with federal tax rules.
  • Equity/public health: Could improve earlier detection among higher‑risk populations (e.g., women with dense breast tissue) by reducing deterrents to follow‑up imaging.

Legislative status and timeline (as provided)

  • Prefiled: 2024‑12‑05. Filed/introduced in legislature and read first time: 2025‑01‑14.
  • Referred to Committee on Labor, Commerce and Industry (and later to Revenue per some actions).
  • Multiple sponsor additions occurred in Jan–Feb 2025.
  • Senate concurred: 2025‑02‑27.
  • Committee hearings scheduled/rescheduled for 09/16/2025 (with virtual hearing updates).
  • Not yet enacted; becomes law only upon gubernatorial approval.

If you want, I can produce a plain‑language one‑page handout for patients explaining how the change would affect out‑of‑pocket costs for follow‑up breast imaging.

Compiled from official sources — confirm details with the bill’s official record.

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