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

April 29, 2025

The Washington State Office of Insurance Commissioner (OIC) 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).

The new guidance directs fully insured non-grandfathered HSA-eligible HDHPs issued or renewed on or after Jan. 1, 2025, to cover the cost share for supplemental and diagnostic breast examinations (including ultrasounds, MRIs and similar screenings).

In compliance with this mandate, effective Jan. 1, 2025, members with HSA-eligible plans in Washington will have no cost-share for these services when seeing in-network providers.

• There will be no no cost share for qualifying breast examinations with in-network providers
• Claims for services performed Jan. 1, 2025 – April 30, 2025, will be reprocessed
• Updated explanation of benefits (EOBs) will be mailed for reprocessed claims
• Providers are expected to refund cost-share payments for these services

Any member who used health savings account (HSA) funds to pay for supplemental or diagnostic breast examinations on or after 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.

• Share this update with your Washington employer groups and members as applicable.
• We will implement similar updates for our Oregon Individual and Group plans once we receive approval from the DFR.

Questions? Please contact your account representative.