Supplemental and diagnostic breast examinations now covered with no cost-share for HSA-eligible plans in Oregon

May 28, 2025

The Oregon DFR has issued implementation guidance based on IRS Notice 2024-75, which addresses cost-sharing requirements for breast examinations in HSA-eligible high-deductible health plans (HDHP).

Effective Jan. 1, 2025, fully insured non-grandfathered HSA-eligible plans and participating ASO groups plans issued or renewed on or after Jan. 1, 2025, will have no cost-share for supplemental and diagnostic breast examinations (including ultrasounds, MRIs and similar screenings).

Large group only: We will distribute updated benefit booklets with the new endorsement for HSA-eligible HDHPs via email if addresses are on file or by mail if no email address is available.

ASO groups only: If you previously accepted mandate OR: 2024 SB 1041:

• Your account representative will contact you to confirm your acceptance of this benefit change if applicable.
• Upon confirmation, we’ll update your Summary Plan Description (SPD).
• If you decline this benefit change, please contact your account representative as additional action may be required.
• If you did not accept original mandate OR: 2024 SB 1041: No action is needed.

Small groups only: Oregon DFR will not accept endorsements for midyear changes to small group plans. The coverage change is effective Jan. 1, 2025, but benefit booklets will not reflect this cost-share update until the 2026 plan year. Group administrators will receive notice via email if addresses are on file or by mail if no email address is available.

• There’s no cost-share for qualifying breast examinations with in-network providers.
• Claims for qualified services performed Jan. 1, 2025 – June 30, 2025, will be reprocessed.
• Members will receive updated EOBs for reprocessed claims.
• Providers are expected to issue refunds to members who already paid for services that now have no cost-share.
• Large group and ASO only: Only large group and ASO plan members will see cost-share updates reflected in their benefit booklets/SPDs in the 2025 plan year.

Any member who used health savings account (HSA) funds to pay for supplemental or diagnostic breast examinations since Jan. 1, 2025, may need to deposit their refund check back into their HSA to avoid tax implications. Members can consult their tax advisor or HSA administrator for guidance.

Questions? Please contact your account representative.