{"data":{"id":"us-ky/krs-304.17-316","jurisdiction":"us-ky","citation":"KRS 304.17-316","heading":"Coverage for mammograms -- Prohibition on cost -sharing","body":"requirements for covered diagnostic breast examinations or supplemental\nbreast examinations.\n(1) As used in this section:\n(a) \"Cost-sharing requirements\" means any:\n1. Deductible, coinsurance, or copayment; or\n2. Out-of-pocket expense imposed upon an insured that is similar to an\nexpense referenced in subparagraph 1. of this paragraph;\n(b) 1. \"Diagnostic breast examination\" means a medically necessary and\nappropriate examination o f the breast that is used to evaluate an\nabnormality seen or suspected from, or detected by, a screening\nexamination for breast cancer or another means of examination.\n2. As used in subparagraph 1. of this paragraph, \"examination of the\nbreast\" includes bu t is not limited to an examination using diagnostic\nmammography, breast magnetic resonance imaging, or breast\nultrasound;\n(c) 1. \"Mammogram\" means an X -ray examination of the breast, with at least\ntwo (2) views of each breast and with an average radiation exposure at\nthe current recommended level as set forth in guidelines of the\nAmerican College of Radiology, using equipment dedicated specifically\nfor mammography, including but not limited to:\na. The X -ray tube, filter, compression device, screens, film, and\ncassettes;\nb. Digital mammography; and\nc. Breast tomosynthesis.\n2. As used in subparagraph 1. of this paragraph, \"breast tomosynthesis\"\nmeans a radiologic procedure that involves the acquisitio n of projection\nimages over the stationary breast to produce cross -sectional digital\nthree-dimensional images of the breast; and\n(d) 1. \"Supplemental breast examination\" means a medically necessary and\nappropriate examination of the breast that is:\na. Used to screen for breast cancer when there is no abnormality seen\nor suspected; and\nb. Based on personal or family medical history, or additional factors,\nthat may increase the individual's risk of breast cancer.\n2. As used in subparagraph 1. of this paragrap h, \"examination of the\nbreast\" includes but is not limited to:\na. A mammogram; and\nb. An examination using breast magnetic resonance imaging or\nbreast ultrasound.\n(2) Subject to subsection (3) of this section and except as otherwise provided in\nsubsection (4) of this section, a health insurance policy, plan, certificate, or contract\nissued, renewed, or delivered in this Commonwealth:\n(a) That provides coverage on an expense -incurred basis for surgical services for\na mastectomy shall also provide coverage for:\n1. a. Low-dose mammography screening for persons who have no sign\nor symptom of breast cancer upon self -referral or referral by a\nhealth care practitioner acting within the scope of the practitioner's\nlicensure.\nb. The coverage required under this subpa ragraph may be limited to\nthe following:\ni. One (1) mammogram for persons ages thirty -five (35) years\nthrough thirty-nine (39) years;\nii. One (1) mammogram every two (2) years for persons ages\nforty (40) years through forty-nine (49) years;\niii. One (1) ma mmogram per year for persons ages fifty (50)\nyears and over; and\niv. A benefit of fifty dollars ($50) per screening mammogram.\nc. The coverage required under this subparagraph shall be subject to\ndeductibles and coinsurance that are no less favorable than the\ndeductibles and coinsurance for coverage for physical illness\ngenerally; and\n2. a. Mammograms for any insured, regardless of age, who has been\ndiagnosed with breast disease upon referral by a health care\npractitioner acting within the scope of the practitioner's licensure.\nb. The coverage required under this subparagraph shall be subject to\nthe same annual deductibles or coinsurance established for other\ncoverages within the policy;\n(b) Shall not impose any cost -sharing requirements for any diagnostic b reast\nexamination or supplemental breast examination that is covered under the\npolicy, plan, certificate, or contract; and\n(c) Shall provide any coverage not otherwise required under this section,\nincluding coverage with respect to restrictions on cost -sharing requirements,\nfor breast examinations, including mammograms, that is required for that\npolicy, plan, certificate, or contract under federal law.\n(3) The coverage required under subsection (2)(a) of this section shall be limited to\nmammograms:\n(a) Performed by a radiographer:\n1. Licensed under KRS Chapter 311B; or\n2. Certified by the American Registry of Radiologic Technologists;\n(b) Interpreted by a qualified radiologist;\n(c) Performed under the direction of a person licensed to practice medicine and\ncertified by the American Board of Radiology;\n(d) Performed by a facility and ordered by a health care practitioner that follow\nfederal laws relating to th e notification of mammography exam results and\nmaintaining medical records;\n(e) Performed by a facility that meets current criteria of the American College of\nRadiology Mammography Accreditation Program; and\n(f) Performed on dedicated equipment that meets the guidelines established by\nthe American College of Radiology.\n(4) If the application of any requirement of subsection (2) of this section would be the\nsole cause of a health insurance policy's, plan's, certificate's, or contract's failure to\nqualify as a Health Savings Account -qualified High Deductible Health Plan under\n26 U.S.C. sec. 223, as amended, then the requirement shall not apply to that policy,\nplan, certificate, or contract until the minimum deductible under 26 U.S.C. sec. 223,\nas amended, is satisfied.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=55750","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:45Z","sha256":"462f7363804b766e5451249cc330ef73fa7d4bc6b3061f1364e446c921b500f5","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17-315","next":"us-ky/krs-304.17-3163"},"notice":"GroundRules: Original legal text. Not legal advice."}