On March 24, 2025, Gov. Glenn Youngkin signed HB 1828/SB 1436, which prohibits insurers and HMOs from charging cost-sharing for diagnostic and supplemental breast examinations, including those using diagnostic mammography, MRI, or ultrasound. The law defines diagnostic breast examinations to include medically necessary and appropriate examinations used to evaluate a detected or suspected abnormality. Supplemental breast examinations are defined as those used to screen for breast cancer based on an individual’s increased risk of breast cancer in the absence of a detected or suspected abnormality.
As enacted, the law applies to group and individual health insurance coverage delivered, issued, or renewed in Virginia on or after January 1, 2026. Employers offering fully insured coverage should be aware of this prohibition and work with their carriers to ensure that any cost-sharing requirements on these examinations are removed for applicable plan years.