Guam § 181003 - Breast Cancer Screening Benefit in Every Health

§ 181003. Breast Cancer Screening Benefit in Every Health

Insurance Policy.

(a) (1) Every policy of health insurance issued or renewed

to a resident of Guam on or after January 1, 2019, except a

policy that provides coverage only for specified and limited

benefits, shall provide coverage for screening by low-dose

mammography for occult breast cancer as follows:

(A) for women thirty-five (35) to thirty-nine (39)

years of age, one (1) baseline mammogram;

(B) for women forty (40) years of age and older,

an annual mammogram; and

(C) for a woman of any age, and for men

beginning at age forty (40) who have a first-degree

consanguineous relative that was diagnosed to have

developed breast cancer at forty (40) years of age or

younger, mammogram screening may be performed as

recommended by the patient’s physician, but not more

than once annually.

(2) The services provided in this Section are not

subject to any coinsurance or deductible provisions which

may be in force in such policies, contracts, plans or

agreements for routine x-ray examinations.

(b) The term, “low-dose mammography” means the x-ray

examination of the breast using equipment dedicated specifically

for mammography, including, but not limited to, the x-ray tube,

filter, compression device, screens, films, and cassettes, with an

average radiation exposure delivery of less than one (1) rad mid-

breast, with two (2) views for each breast, or digital breast

tomosynthesis (DBT), or full-field digital mammography

(FFDM).

(1) Digital breast tomosynthesis (DBT) is a form of

breast imaging, or mammography, that uses a low-dose x-

ray system and computer reconstructions to create three-

dimensional images of the breasts.

(2) Full-field digital mammography (FFDM) is a

mammography system in which the x-ray film is replaced

COL6/24/2021

by electronics that convert x-rays into mammographic

pictures of the breast.

(c) To the extent permitted by federal law, rules, and

regulations, the provisions of this Section, supra, shall apply to

persons covered by Medicaid without the requirement for

precertification. The provisions of this Section, supra, shall also

apply to persons covered by the Medically Indigent Program

(MIP) without the requirement for precertification.