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    Document Summary
    - Report Published -

    Senate Document No. 26

    Document Title
    The Mandated Offer of Coverage for Mammograms Pursuant to Section 38.2-3418.1 of the Code of Virginia

    Special Advisory Commission

    Enabling Authority

    Executive Summary
    Section 38.2-3418.1 of the Code of Virginia requires insurers to offer and make available coverage for low-dose screening mammograms for determining the presence of occult breast cancer. The coverage must include one screening mammogram for persons age 35 through 39, one such mammogram biennially to persons age 40 through 49, and one such mammogram annually to persons age 50 and over. The benefit may be limited to $50 per mammogram and be subject to such dollar limits, deductibles and coinsurance factors that are no less favorable than for physical illness generally.

    The term "mammogram" is defined in the statute to mean:

    "an X-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the X-ray tube, filter, compression device, screens, film and cassettes, with an average radiation exposure of less than one rad mid-breast, two views of each breast."

    In addition, the mammogram must be ordered by a health care practitioner, performed by a registered technologist, interpreted by a qualified radiologist, and performed under the direction of a person licensed to practice medicine and surgery and certified by the American Board of Radiology or an equivalent examining body. The equipment used must meet the standards of the Virginia Department of Health as set forth in its radiation protection regulations. A copy of the mammogram report must also be sent to the health care practitioner who ordered it. Section 38.2-3418.1 was enacted in 1989.

    The Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) held a public hearing during its October 4, 1993 meeting to receive comments regarding the mandated offer of coverage for mammograms. Two speakers were heard and written comments were received from three interested parties.