02-031 C.M.R. ch. 600, § 5 - Policy benefits

Each policy shall provide for screening mammograms performed at least once a year for women of age 40 or over in accordance with the following standards:

A. Policies other than Medicare supplement policies shall provide at least the same level of benefits for screening mammograms as the highest level of coverage provided for other radiological procedures. For the purposes of this Rule, Medicare Risk or Cost Contracts are not considered Medicare supplement policies.

B. Standardized Medicare supplement policies shall provide coverage in accordance with Bureau of Insurance Rule 275. Other Medicare Supplement policies shall provide coverage for screening mammograms on the following basis:

1. The policy must pay a minimum of 80 percent of the Medicare approved amount for screening mammograms. This level of coverage may be reduced if Medicare coverage combined with coverage required by this Rule would exceed the Medicare approved amount. For purposes of this rule, Medicare approved amount means the amount which Medicare recognizes as reasonable, without reduction for coinsurance. A screening mammogram must be covered as required by this rule even if it is not covered by Medicare.

2. If the policy covers physician charges in excess of the Medicare approved amount, it must also cover charges for screening mammograms in excess of the Medicare approved amount on the same basis.

Notes

02-031 C.M.R. ch. 600, § 5