Florida Senate - 2025                                     SB 158
       
       
        
       By Senator Berman
       
       
       
       
       
       26-00164A-25                                           2025158__
    1                        A bill to be entitled                      
    2         An act relating to coverage for diagnostic and
    3         supplemental breast examinations; amending s. 110.123,
    4         F.S.; defining terms; amending s. 110.12303, F.S.;
    5         prohibiting the state group insurance program from
    6         imposing any cost-sharing requirement upon an enrollee
    7         with respect to coverage for diagnostic breast
    8         examinations or supplemental breast examinations;
    9         providing applicability; providing an effective date.
   10          
   11  Be It Enacted by the Legislature of the State of Florida:
   12  
   13         Section 1. Present paragraphs (a), (b) through (p), (q),
   14  and (r) of subsection (2) of section 110.123, Florida Statutes,
   15  are redesignated as paragraphs (b), (d) through (r), (t), and
   16  (u), respectively, new paragraphs (a) and (c) and paragraph (s)
   17  are added to that subsection, and paragraphs (c) and (d) of
   18  subsection (14) of that section are amended, to read:
   19         110.123 State group insurance program.—
   20         (2) DEFINITIONS.—As used in ss. 110.123-110.1239, the term:
   21         (a) “Cost-sharing requirement” means an insured’s
   22  deductible, coinsurance, copayment, or similar out-of-pocket
   23  expense.
   24         (c) “Diagnostic breast examination” means a medically
   25  necessary and appropriate imaging examination of the breast, as
   26  determined in accordance with the most recent applicable
   27  guidelines of the National Comprehensive Cancer Network,
   28  including, but not limited to, an examination using diagnostic
   29  mammography, breast magnetic resonance imaging, or breast
   30  ultrasound, which is used to evaluate an abnormality that is
   31  seen or suspected during a screening examination for breast
   32  cancer.
   33         (s) “Supplemental breast examination” means a medically
   34  necessary and appropriate imaging examination of the breast,
   35  conducted in accordance with the most recent applicable
   36  guidelines of the National Comprehensive Cancer Network,
   37  including, but not limited to, an examination using breast
   38  magnetic resonance imaging or breast ultrasound, which is:
   39         1. Used to screen for breast cancer when there is no
   40  abnormality seen or suspected; and
   41         2. Based on personal or family medical history or
   42  additional factors that may increase the person’s risk of breast
   43  cancer.
   44         (14) OTHER-PERSONAL-SERVICES EMPLOYEES (OPS).—
   45         (c) The initial measurement period used to determine
   46  whether an employee hired before April 1, 2013, and paid from
   47  OPS funds is a full-time employee described in subparagraph
   48  (2)(g)1. (2)(e)1. is the 6-month period from April 1, 2013,
   49  through September 30, 2013.
   50         (d) All other measurement periods used to determine whether
   51  an employee paid from OPS funds is a full-time employee
   52  described in paragraph (2)(g) (2)(e) must be for 12 consecutive
   53  months.
   54         Section 2. Present subsections (5) and (6) of section
   55  110.12303, Florida Statutes, are redesignated as subsections (6)
   56  and (7), respectively, and a new subsection (5) is added to that
   57  section, to read:
   58         110.12303 State group insurance program; additional
   59  benefits; price transparency program; reporting.—
   60         (5) In any contract or plan for state employee health
   61  benefits which provides coverage for diagnostic breast
   62  examinations or supplemental breast examinations, the state
   63  group insurance program may not impose any cost-sharing
   64  requirement upon an enrollee. If, under federal law, the
   65  application of this subsection would result in health savings
   66  account ineligibility under s. 223 of the Internal Revenue Code,
   67  the prohibition under this subsection applies only to health
   68  savings account qualified high-deductible health plans with
   69  respect to the deductible of such a plan after the person has
   70  satisfied the minimum deductible under s. 223 of the Internal
   71  Revenue Code, except with respect to items or services that are
   72  preventive care pursuant to s. 223(c)(2)(C) of the Internal
   73  Revenue Code, in which case the requirements of s. 223(c)(2)(A)
   74  of the Internal Revenue Code apply regardless of whether the
   75  minimum deductible under s. 223 of the Internal Revenue Code has
   76  been satisfied.
   77         Section 3. This act shall take effect January 1, 2026.