The Vermont Statutes Online
The Statutes below include the actions of the 2024 session of the General Assembly.
NOTE: The Vermont Statutes Online is an unofficial copy of the Vermont Statutes Annotated that is provided as a convenience.
Title 8 : Banking and Insurance
Chapter 107 : Health Insurance
Subchapter 007 : MAMMOGRAMS
(Cite as: 8 V.S.A. § 4100a)-
§ 4100a. Mammograms; coverage required [Effective until January 1, 2026; see also 8 V.S.A. § 4100a effective January 1, 2026, set out below]
(a) Insurers shall provide coverage for screening by mammography for the presence of breast cancer. In addition, insurers shall provide coverage for screening by ultrasound for a patient for whom the results of a screening mammogram were inconclusive or who has dense breast tissue, or both. Benefits provided shall cover the full cost of the mammography service or ultrasound, as applicable, and shall not be subject to any co-payment, deductible, coinsurance, or other cost-sharing requirement or additional charge.
(b) [Repealed.]
(c) This section shall apply only to screening procedures conducted by test facilities accredited by the American College of Radiologists.
(d) As used in this subchapter:
(1) “Insurer” means any insurance company that provides health insurance as defined in subdivision 3301(a)(2) of this title, nonprofit hospital and medical service corporations, and health maintenance organizations. The term does not apply to coverage for specified diseases or other limited benefit coverage.
(2) “Mammography” means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and digital detector. The term includes breast tomosynthesis.
(3) “Screening” includes the mammography or ultrasound test procedure and a qualified physician’s interpretation of the results of the procedure, including additional views and interpretation as needed. (Added 1991, No. 40, § 1, eff. Sept. 1, 1991; amended 2007, No. 160 (Adj. Sess.), § 1, eff. Oct. 1, 2008; 2013, No. 25, §§ 1, 4; 2017, No. 141 (Adj. Sess.), § 1, eff. Jan. 1, 2019.)
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§ 4100a. Mammograms and other breast imaging services; coverage required [Effective January 1, 2026; see also 8 V.S.A. § 4100a effective until January 1, 2026, set out above]
(a)(1) Insurers shall provide coverage for screening mammography and for other medically necessary breast imaging services upon recommendation of a health care provider as needed to detect the presence of breast cancer and other abnormalities of the breast or breast tissue. In addition, insurers shall provide coverage for screening by ultrasound or another appropriate imaging service for a patient for whom the results of a screening mammogram were inconclusive or who has dense breast tissue, or both.
(2) Benefits provided shall cover the full cost of the mammography, ultrasound, and other breast imaging services and shall not be subject to any co-payment, deductible, coinsurance, or other cost- sharing requirement or additional charge, except to the extent that such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.
(b) [Repealed.]
(c) This section shall apply only to procedures conducted by test facilities accredited by the American College of Radiologists.
(d) As used in this subchapter:
(1) “Insurer” means any insurance company that provides health insurance as defined in subdivision 3301(a)(2) of this title, nonprofit hospital and medical service corporations, and health maintenance organizations. The term does not apply to coverage for specified diseases or other limited benefit coverage.
(2) “Mammography” means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and digital detector. The term includes breast tomosynthesis.
(3) “Other breast imaging services” means diagnostic mammography, ultrasound, and magnetic resonance imaging services that enable health care providers to detect the presence or absence of breast cancer and other abnormalities affecting the breast or breast tissue.
(4) “Screening” includes the mammography or ultrasound test procedure and a qualified physician’s interpretation of the results of the procedure, including additional views and interpretation as needed. (Added 1991, No. 40, § 1, eff. Sept. 1, 1991; amended 2007, No. 160 (Adj. Sess.), § 1, eff. Oct. 1, 2008; 2013, No. 25, §§ 1, 4; 2017, No. 141 (Adj. Sess.), § 1, eff. Jan. 1, 2019; 2023, No. 94 (Adj. Sess.), § 1, eff. January 1, 2026.)
