3-D Mammography Preventive Service Mandate

On January 16, 2018, New Jersey enacted a new benefit mandate that requires health insurance coverage without cost sharing for digital tomosynthesis (3-D mammography) to detect or screen for breast cancer in women ages 40 years or older. This new mandate is effective for Insured Plans and Policies, and the State Health Benefits Program issued or renewed on or after August 1, 2018.

Digital tomosynthesis creates a three-dimensional picture of the breast using several low-dose X-ray images from different angles as the scanner moves in an arc around the breast. Conventional mammography produces one image of overlapping tissue. The difference between the images produced by tomosynthesis and conventional mammography has been described as being similar to a ball (3-D) versus a circle (flat).

One preventive 3-D mammography and one preventive 2-D mammography are covered during one benefit year. If 3-D mammography is provided for diagnostic purposes in women of any age, then cost sharing would apply.

Self-funded groups have the option to participate with this mandate. If the self-funded group chooses to opt in to the mandate, they will receive the full coverage benefit of the mandate. If they choose not to opt in to this mandate, they will be covered, where applicable, by the Federal Affordable Care Act regulation, which only requires a 2-D mammogram.

Published on: July 4, 2018, 02:57 AM ET
Last updated on: July 10, 2018, 01:27 AM ET