H.R. 3037 — Access to Breast Cancer Diagnosis Act of 2025

This section establishes a new requirement under the Public Health Service Act (PHS Act) for group health plans and health insurance issuers offering group or individual coverage to provide diagnostic breast examinations (i.e., for abnormalities seen or suspected on screening, per National Comprehensive Cancer Network guidelines) and supplemental breast examinations (i.e., for high-risk screening without abnormality) with no cost-sharing requirements (i.e., no deductibles, coinsurance, copayments, or out-of-pocket maximums), if such benefits are provided; permits prior authorization and utilization controls; and preserves stronger state laws. It applies this requirement to grandfathered health plans (i.e., those enrolled in before March 23, 2010, generally exempt from many Affordable Care Act reforms) by amending section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act (1) to cover PHS Act provisions added after ACA enactment and (2) to explicitly include new section 2730. The section provides a safe harbor under the Internal Revenue Code ensuring high-deductible health plans remain eligible for health savings accounts despite waiving deductibles for these examinations. All changes apply to plan years beginning on or after January 1, 2026.