RI 2026 H7276: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This legislation mandates that health insurance providers in Rhode Island cover the full cost of diagnostic and supplemental breast examinations. It applies to various types of insurance plans, including nonprofit hospital and medical service corporations and health maintenance organizations (HMOs). The bill explicitly prohibits insurers from imposing any cost-sharing requirements, such as deductibles, copayments, or coinsurance, for these specific exams. Diagnostic exams are defined as those evaluating detected abnormalities, while supplemental exams are screenings for individuals with higher risk factors. The coverage includes mammography, MRI, and ultrasound.

For younger readers

Sometimes, doctors need to take special pictures of the inside of a person's body to check for sickness. This bill makes a new rule for health insurance companies. It says that if a person needs a special check-up for breast cancer because the doctor found something wrong, or because the person has a high chance of getting sick, the insurance company must pay for all of it. The person getting the check-up will not have to pay any extra money, like a copay, to the doctor. This helps make sure people can get checked without worrying about the cost.

Who & Where It Applies

Impacted groups

WomenHealth Insurance CompaniesBreast Cancer PatientsRadiologistsIndividuals with family history of cancer

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

Amount unknown

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Eliminates financial barriers to healthcare by removing copays and deductibles, ensuring that low-income individuals can access life-saving diagnostic services without fear of debt.
Promotes health equity and social justice by addressing the specific healthcare needs of women, a group that has historically faced gender-based disparities in medical costs and treatment access.
Strengthens the social safety net by mandating that private corporations prioritize community health and preventative care over profit margins and cost-shifting measures.
Relies on and regulates the existing for-profit private insurance industry rather than moving the state toward a systemic reform like universal, single-payer public healthcare.
May lead insurance companies to raise monthly premiums for all policyholders to recoup lost revenue, which could inadvertently place a higher financial burden on working-class families.
Addresses only one specific medical condition, failing to provide a comprehensive solution for cost-free diagnostics for other serious illnesses affecting the poor and disadvantaged.

For Conservatives

Supports the preservation of the family unit by facilitating early detection and treatment of life-threatening illnesses in mothers, wives, and daughters.
Encourages fiscal responsibility in the long term, as early detection of cancer is significantly less expensive to treat than late-stage cancer, potentially reducing overall healthcare spending.
Focuses strictly on medically necessary diagnostics for serious physical illness rather than mandating coverage for elective, cosmetic, or controversial social-agenda procedures.
Violates principles of corporate freedom by forcing private businesses to offer services at a specific price point (free) and dictating the terms of private contracts.
Likely results in increased insurance premiums for all consumers, acting as a hidden cost that penalizes the broader insurance pool to subsidize specific services.
Represents government overreach into the healthcare market, setting a precedent for further state intervention in how private companies manage risk and costs.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 84 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-42.1. Diagnostic and supplemental breast examination.

(a) As used in this section, the following words shall have the following meanings:

(1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

(2) "Diagnostic breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

(i) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or

(ii) Used to evaluate an abnormality detected by another means of examination.

(3) "Supplemental breast examinations" means a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging, or breast ultrasound, that is:

(i) Used to screen for breast cancer when there is no abnormality seen or suspected; and

(ii) Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.

(b) In the case that a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening, supplemental and diagnostic breast examinations furnished to an individual enrolled under such plan or such coverage, the plan or coverage shall not impose any cost-sharing requirements.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-34.2. Diagnostic and supplemental breast examination.