RI 2026 H8246: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This legislation mandates that individual and group health insurance plans in Rhode Island provide coverage for follow-up lung cancer screenings and diagnostic services. The coverage must align with current American Cancer Society guidelines. The bill prohibits insurers from charging copayments, deductibles, or coinsurance for these specific services, effectively making them free at the point of care for the patient. However, an exception is made for health plans paired with federally qualified Health Savings Accounts (HSAs), which may still apply a deductible. The requirement applies to insurance policies issued or renewed on or after January 1, 2027.

For younger readers

This new rule helps people stay healthy by making sure they can get checked for lung cancer without worrying about money. It tells health insurance companies—the businesses that help pay for doctor visits—that they must pay for special tests to see if someone has lung cancer. Usually, people have to pay a small fee called a "copay" when they go to the doctor, but this rule says they don't have to pay anything for these tests. This helps people catch sickness early so they can get better.

Who & Where It Applies

Impacted groups

Health insurance companiesPatients at risk for lung cancerRadiologists and diagnostic imaging centersEmployers providing group health insuranceOncologists

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Eliminates financial barriers to healthcare by removing copayments and deductibles for life-saving cancer screenings, ensuring that low-income individuals are not deterred from seeking necessary preventative care due to cost.
Promotes health equity by mandating coverage based on American Cancer Society guidelines, ensuring that all insured residents, regardless of their specific insurance plan, have access to the same high standard of diagnostic services.
Prioritizes public health and community welfare by facilitating early detection of lung cancer, which significantly improves survival rates and reduces the long-term burden of advanced disease on the social safety net.
Includes a loophole for Health Savings Account (HSA) plans that allows them to still charge deductibles, potentially leaving some patients with high out-of-pocket costs despite the legislation's intent.
Allows insurance companies to continue using "medical management" and "utilization review" tactics, which corporations often use to delay or deny care even when it is recommended by a provider.
Delays the mandatory implementation date until January 1, 2027, leaving a gap of several years during which patients may continue to face financial barriers to screening.

For Conservatives

Respects federal tax law and financial planning tools by explicitly exempting Health Savings Account (HSA) qualified plans from the deductible ban, preserving the tax-advantaged status of these accounts.
Maintains mechanisms for fraud prevention and cost control by explicitly permitting insurers to utilize medical management and preauthorization reviews to ensure services are medically necessary.
Encourages early detection of serious illness, which can reduce the catastrophic costs associated with late-stage cancer treatment, aligning with fiscal responsibility regarding long-term healthcare spending.
Imposes a government mandate on private businesses (insurance companies), interfering with the free market and the ability of corporations to design their own products and contracts.
Will likely result in increased insurance premiums for all policyholders, as the costs of "free" screenings are shifted to the collective risk pool, effectively acting as a hidden tax on consumers.
Reduces consumer choice by forcing all plans to include specific benefits, preventing individuals from choosing lower-cost, catastrophic-only coverage if they prefer it.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 78 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: 27-18-96. Insurance coverage for lung cancer screening.

(a) The Rhode Island general assembly recognizes that lung cancer remains the leading cause of cancer deaths in Rhode Island and further that early detection of lung cancer will ensure that patients get the critical care they need without delay. Accordingly, it is in the best interests of the people of the state to promote widespread availability by eliminating out-of-pocket costs for lung cancer screenings.

(b) Every individual or group health insurance contract, plan, or policy that provides coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall provide coverage for follow-up screening or diagnostic services for lung cancer upon the recommendation of a health care provider acting within the provider's scope of practice, and as recommended by current American Cancer Society guidelines for lung cancer screening. There shall be no copayment required, and no deductible shall need to be met for follow- up screening or diagnostic services for lung cancer. A deductible may be applied to health plans that are paired with a federally qualified health savings account pursuant to 26 U.S.C. § 223. Nothing in this section would prohibit a health plan from implementing this benefit prior to January 1, 2027.

(c) Nothing in this section shall be construed to prevent medical management or utilization review of the services, including preauthorization, to ensure that such services are consistent with current American Cancer Society guidelines for lung cancer screening.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Insurance coverage for lung cancer screening.

(a) The Rhode Island general assembly recognizes that lung cancer remains the leading cause of cancer deaths in Rhode Island and further that early detection of lung cancer will ensure that patients get the critical care they need without delay. Accordingly, it is in the best interests of the people of the state to promote widespread availability by eliminating out-of-pocket costs for lung cancer screenings.

(b) Every individual or group health insurance contract, plan, or policy that provides coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall provide coverage for all follow-up screening or diagnostic services for lung cancer that are administered at a frequency identified in the current American Cancer Society guidelines, including follow up examinations. Follow up examinations include, but are not limited to, chest x-ray, computed tomography scan, magnetic resonance imaging, positron emission tomography, or biopsy. There shall be no copayment, coinsurance, or any other cost-sharing required, and no deductible shall need to be met for follow-up screening or diagnostic services for lung cancer. A deductible may be applied to health plans that are paired with a federally qualified health savings account pursuant to 26 U.S.C. § 223. Nothing in this section would prohibit a health plan from implementing this benefit prior to January 1, 2027.

(c) Nothing in this section shall be construed to prevent medical management or utilization review of the services, including preauthorization, to ensure that such services are consistent with current American Cancer Society guidelines for lung cancer screening.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-84. Insurance coverage for lung cancer screening.

(a) The Rhode Island general assembly recognizes that lung cancer remains the leading cause of cancer deaths in Rhode Island and further that early detection of lung cancer will ensure that patients get the critical care they need without delay. Accordingly, it is in the best interests of the people of the state to promote widespread availability by eliminating out-of-pocket costs for lung cancer screenings.

(b) Every individual or group health insurance contract, plan, or policy that provides coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall provide coverage for all follow-up screening or diagnostic services for lung cancer upon the recommendation of a health care provider acting within the provider's scope of practice, and as recommended by current American Cancer Society guidelines for lung cancer screening. There shall be no copayment, coinsurance, or any other cost-sharing required, and no deductible shall need to be met for follow-up screening or diagnostic services for lung cancer. A deductible may be applied to health plans that are paired with a federally qualified health savings account pursuant to 26 U.S.C. § 223. Nothing in this section would prohibit a health plan from implementing this benefit prior to January 1, 2027.

(c) Nothing in this section shall be construed to prevent medical management or utilization review of the services, including preauthorization, to ensure that such services are consistent with current American Cancer Society guidelines for lung cancer screening.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-101. Insurance coverage for lung cancer screening.

(a) The Rhode Island general assembly recognizes that lung cancer remains the leading cause of cancer deaths in Rhode Island and further that early detection of lung cancer will ensure that patients get the critical care they need without delay. Accordingly, it is in the best interests of the people of the state to promote widespread availability by eliminating out-of-pocket costs for lung cancer screenings.

(b) Every individual or group health insurance contract, plan, or policy that provides coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall provide coverage for all follow-up screening or diagnostic services for lung cancer that are administered at a frequency identified in the current American Cancer Society guidelines, including follow up examinations. Follow up examinations include, but are not limited to, chest x-ray, computed tomography scan, magnetic resonance imaging, positron emission tomography, or biopsy. There shall be no copayment, coinsurance, or any other cost-sharing required, and no deductible shall need to be met for follow-up screening or diagnostic services for lung cancer. A deductible may be applied to health plans that are paired with a federally qualified health savings account pursuant to 26 U.S.C. § 223. Nothing in this section would prohibit a health plan from implementing this benefit prior to January 1, 2027.

(c) Nothing in this section shall be construed to prevent medical management or utilization review of the services, including preauthorization, to ensure that such services are consistent with current American Cancer Society guidelines for lung cancer screening.

SECTION 5. This act shall take effect upon passage.