Florida Statutes 641.31095 – Coverage for mammograms
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(1) Every health maintenance contract issued or renewed on or after January 1, 1996, shall provide coverage for at least the following:
(a) A baseline mammogram for any woman who is 35 years of age or older, but younger than 40 years of age.
Terms Used In Florida Statutes 641.31095
- Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
- Contract: A legal written agreement that becomes binding when signed.
- Copayment: means a specific dollar amount, except as otherwise provided for by statute, that the subscriber must pay upon receipt of covered health care services. See Florida Statutes 641.19
- Health maintenance organization: means any organization authorized under this part which:(a) Provides, through arrangements with other persons, emergency care, inpatient hospital services, physician care including care provided by physicians licensed under chapters 458, 459, 460, and 461, ambulatory diagnostic treatment, and preventive health care services. See Florida Statutes 641.19
- Subscriber: means an entity or individual who has contracted, or on whose behalf a contract has been entered into, with a health maintenance organization for health care coverage or other persons who also receive health care coverage as a result of the contract. See Florida Statutes 641.19
(b) A mammogram every 2 years for any woman who is 40 years of age or older, but younger than 50 years of age, or more frequently based on the patient’s physician’s recommendations.(c) A mammogram every year for any woman who is 50 years of age or older.(d) One or more mammograms a year, based upon a physician’s recommendation for any woman who is at risk for breast cancer because of a personal or family history of breast cancer, because of having a history of biopsy-proven benign breast disease, because of having a mother, sister, or daughter who has had breast cancer, or because a woman has not given birth before the age of 30.
(2) The coverage required by this section is subject to the deductible and copayment provisions applicable to outpatient visits, and is also subject to all other terms and conditions applicable to other benefits. A health maintenance organization shall make available to the subscriber as part of the application, for an appropriate additional premium, the coverage required in this section without such coverage being subject to any deductible or copayment provisions in the contract.