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Mississippi Code Title 83. Insurance § 83-9-403

Current as of January 01, 2025 | Updated by Findlaw Staff

(1) As used in this section, the following terms shall be defined as provided in this subsection:

(a) “Cost-sharing requirements” means a deductible, coinsurance, copayment or similar out-of-pocket expense.

(b) “Diagnostic breast examinations” means a medically necessary and appropriate (in accordance with National Comprehensive Cancer Network Guidelines) examination of the breast, including, but not limited to, such an examination using contrast-enhanced mammography, diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

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

(ii) Used to evaluate an abnormality detected by another means of examination.

(c) “Supplemental breast examinations” means a medically necessary and appropriate (in accordance with National Comprehensive Cancer Network Guidelines) examination of the breast, including, but not limited to, such an examination using contrast-enhanced mammography, diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

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

(ii) Based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer.

(2) If a group health plan, or a health insurance issuer offering group or individual health insurance coverage, provides benefits with respect to screening, diagnostic breast examinations and supplemental breast examinations furnished to an individual enrolled under such plan, such plan shall not impose any cost-sharing requirements for those services.

(3) If under federal law, application of subsection (2) of this section would result in health savings account ineligibility under Section 223 of the federal Internal Revenue Code, this requirement shall apply only for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under Section 223, except for with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of subsection (2) shall apply regardless of whether the minimum deductible under Section 223 has been satisfied.

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Cite this article: FindLaw.com - Mississippi Code Title 83. Insurance § 83-9-403 - last updated January 01, 2025 | https://codes.findlaw.com/ms/title-83-insurance/ms-code-sect-83-9-403/

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