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3-D Mammography Preventive Service Mandate

July 26, 2018

Applies to: All commercial markets

On January 16, 2018, the state of New Jersey enacted a new benefit mandate that requires health insurance coverage without cost sharing for digital tomosynthesis (three-dimensional or 3-D mammography) to detect or screen for breast cancer in women age 40 years and older. This mandate is effective for fully insured health plans and the State Health Benefits Program issued or renewed on or after August 1, 2018. Self-funded health plans can choose to offer this mandated benefit.

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 conventional mammography are covered during each benefit year. However, if a mammography is provided for diagnostic purposes in women of any age, then cost sharing may apply.

Self-funded groups have the option to participate with this mandate. If your self-funded group client opts into the mandate, its employees will receive the full coverage benefit of the mandate. If your self-funded group client opts out of this mandate, its employees will be covered, where applicable, by the federal Affordable Care Act, which only covers a conventional mammogram.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

Published on: July 30, 2018, 03:57 AM ET
Last updated on: August 1, 2018, 02:55 AM ET