An Act to prohibit cost-sharing in certain health insurance policies for diagnostic and supplemental breast imaging examinations.

Be it enacted by the Legislature of the State of South Dakota:

Section 1. That a NEW SECTION be added to chapter 58-17:

A health insurance policy may not impose any cost-sharing requirement on an individual enrolled under the policy with respect to a screening examination, diagnostic breast examination, or supplemental breast examination, when the examination is medically necessary.

Terms used in this section mean:

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

(2) "Diagnostic breast examination," a medically necessary and appropriate examination of the breast, in accordance with nationally recognized guidelines, that is:

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

(b) Used to evaluate an abnormality detected by another means of examination; and

(3) "Supplemental breast examination," a medically necessary and appropriate examination of the breast, in accordance with nationally recognized guidelines, that is:

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

(b) Based on personal or family medical history, extremely dense or heterogeneously dense breasts, or other factors that increase the individual's risk of breast cancer.

If an application of this section would result in the ineligibility of a health savings account under 26 U.S.C. § 223 (June 1, 2025), this section applies only to a health savings account-qualified high deductible health plan's deductible after the enrolled individual has satisfied the minimum deductible under 26 U.S.C. § 223. An item or service that is for preventative care, pursuant to 26 U.S.C. § 223(c)(2)(C) (June 1, 2025), may not be considered as satisfying the minimum deductible.

Section 2. That a NEW SECTION be added to chapter 58-18:

A group health insurance policy may not impose any cost-sharing requirement on an individual enrolled under the policy with respect to a screening examination, diagnostic breast examination, or supplemental breast examination, when the examination is medically necessary.

Terms used in this section mean:

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

(2) "Diagnostic breast examination," a medically necessary and appropriate examination of the breast, in accordance with nationally recognized guidelines, that is:

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

(b) Used to evaluate an abnormality detected by another means of examination; and

(3) "Supplemental breast examination," a medically necessary and appropriate examination of the breast, in accordance with nationally recognized guidelines, that is:

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

(b) Based on personal or family medical history, extremely dense or heterogeneously dense breasts, or other factors that increase the individual's risk of breast cancer.

If an application of this section would result in the ineligibility of a health savings account under 26 U.S.C. § 223 (June 1, 2025), this section applies only to a health savings account-qualified high deductible health plan's deductible after the enrolled individual has satisfied the minimum deductible under 26 U.S.C. § 223. An item or service that is for preventative care, pursuant to 26 U.S.C. § 223(c)(2)(C) (June 1, 2025), may not be considered as satisfying the minimum deductible.