Morris Manning & Martin, LLP

Directive 22-EX-4: Coverage For Diagnostic Examinations For Breast Cancer


On June 30, 2022, Commissioner John F. King issued Directive 22-EX-4 to advise insurance carriers of new requirements pursuant to HB 733 and the interpretation of such by the Office of Commissioner of Insurance and Safety Fire (the Department). Effective May 6, 2022, HB 733 amended O.C.G.A §33-24-59.31 with new requirements on health benefit policies issued, delivered, issued for delivery or renewed on or after January 1, 2023.

The relevant portion of HB 733 states “A health benefit policy that provides coverage for diagnostic examinations for breast cancer shall include provisions that ensure that the cost-sharing requirements applicable to diagnostic and supplemental breast screening examinations are no less favorable than the cost-sharing requirements applicable to screening mammography for breast cancer.”

In order to determine if the cost-sharing requirement is met, the Department will look to the actual dollar value the insured is expected to pay (the out-of-pocket costs to the consumer) rather than the percentage of the cost of the procedure to the insured. For example, if a policy provided $50 out-of-pocket costs for a screening mammography, the Department expects the same or less out-of-pocket costs for diagnostic and supplemental breast screening examinations.

Written by Tony Roehl for the Federation of Regulatory Counsel (FORC).