Health Insurance Coverage for Diagnostic Breast Imaging

State of Vermont For consumer assistance: Department of Financial Regulation [Banking] 888-568-4547 89 Main Street [Insurance] 800-964- 1784 Montpelier, VT 05620-3101 [Securities] 877-550-3907 www.dfr.vermont.gov Insurance Bulletin #235 Health insurance coverage for diagnostic breast imaging August 15, 2025 The purpose of this bulletin is to clarify the Department’s enforcement date of Act 94 of 2023 (H.621), An act relating to health insurance coverage for breast imaging, due to the potential impact of Act 11 (S.30) of 2025, An act relating to updating and reorganizing the health insurance statutes in 8 V.S.A. chapter 107. Under Act 94 of 2023, the Legislature amended 8 V.S.A. § 4095, Vermont’s mammography and breast imaging statute, to require coverage of diagnostic mammography and breast imaging to detect the presence of breast cancer and other abnormalities of the breast or breast tissue without member cost-sharing. This change is effective January 1, 2026, as insurance plans are offered, issued or renewed but no later than January 1, 2027. Under Act 11 of 2025, the Legislature updated and reorganized 8 V.S.A. chapter 107, introducing consistent language and terminology. Act 11 of 2025 incorporated the changes made in Act 94 of 2023 and renumbered 8 V.S.A. § 4095 to 8 V.S.A. § 4095b. The Legislature made Act 11 of 2025 effective September 1, 2025, including the changes to Vermont’s mammography and breast imaging statute under Act 94 of 2023. Because the Legislature intended that in Act 11 of 2025 “the substantive changes in other acts shall take precedence over the technical changes in this act”, the Department has determined that the effective date in Act 94 of 2023 takes precedence with respect to mammography and breast imaging coverage. See Act 11 of 2025, § 32. Therefore, the Department will not enforce Act 94 of 2023’s changes until January 1, 2026. Inquiries about this bulletin should be directed to the Director of Health Insurance Regulation. _________________________ Kaj Samsom, Commissioner of Financial Regulation _________________________ Date Docusign Envelope ID: 182A1FA3-51F7-4610-981C-AA9866411ECA 8/8/2025