Nov. 9, 2022

Oklahoma HB 3504 Diagnostic Breast Imaging

Applies to ASO, fully insured, Blue Balance Funded^SM, grandfathered and transitional plans
Oklahoma House Bill (HB) 3504 has updated the existing requirements around breast cancer screenings to include diagnostic breast screenings without member cost sharing.

What You Need to Know:
Except for High Deductible Health Plans (HDHP) with Health Savings Accounts (HSAs), the following services will no longer be subject to member cost sharing when care is received at an in-network provider*:

• Diagnostic Mammogram
• Diagnostic Ultrasound
• Diagnostic Breast MRI

Members with HSA plans need to meet their deductible before these diagnostic screenings can be covered without cost sharing.

• Members do not need to meet their deductible before their preventive screenings will continue to be covered without cost sharing.

When does this go into effect?
The change was effective for new or renewing plans on Nov. 1, 2022.

Does this law apply to ASO groups?
ASO groups may want to consult their own legal counsel to determine if the mandate applies to their plans. If an ASO group wants to update their benefits to align with the fully insured standard, they should work with their account representatives.

*Services received at an out-of-network provider may be subject to balance billing.