State Laws - Glossary of Terms
Types of Laws:
Federal breast cancer screening law - most group and individual health insurance plans in the U.S. must cover annual breast cancer screening mammograms (including tomosynthesis/3D mammograms) with no copay, deductible, or coinsurance for women, starting at age 40. This coverage applies to in-network providers and facilities only.
- Mammograms before age 40 and screening with other technologies such as MRI or ultrasound are not covered by federal law; cost-sharing applies unless a state law requires coverage with no out-of-pocket costs.
State laws - apply to specified health plans in the state. Employers typically must abide by the laws in the state where they are based. A health plan does not have to follow laws from other states where employees may reside. For example, if you live in New Jersey but work for a company based in New York, the insurance policy follows New York laws—even for employees who live in nearby states. Check with your employer for more information.
Payment Terms:
Coinsurance - the percentage of a covered healthcare service’s cost that you pay after meeting your deductible.
Copay - a fixed amount of money you pay for certain medical services. The remaining balance is typically covered by the insurance company.
Cost-sharing - the costs you pay for the services provided, often referred to as your copay, coinsurance, and/or deductible. The health insurance premium is separate from these costs.
Deductible - the amount you must pay for covered healthcare services before insurance begins paying. Note that copays don’t always count toward your deductible.
No cost-sharing - no out-of-pocket costs apply to the health services provided (including copay, coinsurance, and deductible) so they are “free” to the patient.
Types of Tests/Imaging:
Diagnostic imaging - medical tests and/or examinations following a suspicious mammogram or other type of breast exam that requires further imaging to determine if cancer is present
Supplemental/high-risk screening - Breast cancer screening for individuals at increased risk of breast cancer due to a genetic predisposition or other factors, including (but not limited to) MRI, ultrasound, digital breast tomosynthesis/3D mammogram.
Screening Guideline Organizations:
American College of Radiology (ACR) - A medical professional society representing radiologists, radiation oncologists, and related specialties that establishes screening guidelines for cancer and other health conditions.
National Comprehensive Cancer Network (NCCN) - A national alliance that develops evidence-based guidelines to inform cancer prevention and treatment. FORCE shares NCCN guidelines for individuals at increased risk of cancer on our website.