Matt Lesser

Sen. Lesser Leads Passage Of Bill Expanding Health Insurance Coverage For Breast Cancer & Ovarian Cancer

State Senator Matt Lesser (D-Middletown), Chair of the Insurance & Real Estate Committee, led passage on a bill that passed this legislative session that will expand health insurance requirements to provide screenings and treatments for breast cancer. Senate Bill 358, ‘An Act Concerning Required Health Insurance Coverage For Breast And Ovarian Cancer Susceptibility Screening,’ will expand insurance coverage requirements for mammograms, ultrasounds, and magnetic resonance imaging (MRIs) for breast screenings under state-regulated health insurance policies. It will also require insurance policies to cover testing and treatment of ovarian cancer.

“I was proud to spearhead Senate passage of this critically important health care bill,” said Sen. Lesser. “Connecticut is poised to have the strongest law in the country covering early detection and treatment of breast and ovarian cancer. As a cancer survivor myself, I know early detection saves lives. I was thrilled to work with local advocates and my House colleagues to champion this critically important bill.”

Currently, the affected insurance policies must cover a baseline mammogram for a woman aged 35 to 39 and an annual mammogram for a woman aged 40 or older. This bill also requires these policies to cover diagnostic and screening mammograms at these age intervals. It also requires the policies to cover a baseline mammogram for an insured who is younger than age 35 and an annual mammogram for an insured who is younger than age 40 if the insured is believed to be at an increased risk for breast cancer.

According to the American Cancer Society, breast cancer is the most common cancer in women in the United States, except for skin cancers. It is about 30% (or 1 in 3) of all new female cancers each year. In recent years, incidence rates have increased by 0.5% per year. Breast cancer is the second leading cause of cancer death in women. The American Cancer Society estimates about 19,880 women will receive a new diagnosis of ovarian cancer. Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system.

According to Hartford HealthCare, Connecticut has one of the highest rates of breast cancer in the country. And according to the Department of Public Health, Ovarian cancer is the 5th-leading cause of cancer deaths, and the 8th most common type of cancer, in CT women. It is diagnosed in 3% of Connecticut women. Mortality, and relative survival rates of ovarian cancer in CT are similar to those observed at the national level.

Early detection can save lives. Nearly 38,000 women in Connecticut are not receiving all of the health care they need because they do not have proper health insurance or the means to pay health insurance premiums. If insurance policies are expanded to cover testing and treatment, it will result in finding breast cancer and/or Ovarian cancer earlier through screening and increased awareness as well as better treatments.

SB 358 will require insurance policies to cover certain procedures related to breast cancer treatment, including breast biopsies; certain prophylactic mastectomies; and breast reconstruction surgery, subject to certain conditions. Additionally, the bill requires these health insurance policies to cover the following services related to the testing and treatment of ovarian cancer:

• Genetic testing, including for breast cancer gene one (BRCA1) and breast cancer gene two (BRCA2)
• Post-treatment CA-125 monitoring (i.e., a test measuring the amount of the cancer antigen 125 protein)
• Routine ovarian cancer screenings, including surveillance tests for certain insureds.

Current law requires the policies to cover a woman’s breast MRI in accordance with American Cancer Society guidelines. The bill instead requires the policies to cover both diagnostic and screening breast MRIs in accordance with the American Cancer Society guidelines for an insured who is age 35 or older or younger than age 35 who is at increased breast cancer risk.

The bill requires policies to also cover breast biopsies, prophylactic mastectomies, and breast reconstructive surgery. It prohibits the policies from imposing cost sharing (coinsurance, copayments, deductibles, or other out-of-pocket expenses) for the covered services.

Senate Bill 358 also will adopt gender neutral language, specifying mammography, ultrasound, and certain other coverage applies to any insured and not just women.