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PRINTER'S NO. 3510
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2842
Session of
2022
INTRODUCED BY McNEILL, MILLARD, ZABEL, MADDEN, HILL-EVANS,
SAMUELSON, N. NELSON, HOHENSTEIN, BURGOS, KIM, SANCHEZ,
WELBY, DELLOSO, HENNESSEY, T. DAVIS, WARREN, KINSEY,
BIZZARRO, ISAACSON, HANBIDGE, ABNEY AND NEILSON,
SEPTEMBER 21, 2022
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 21, 2022
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for coverage for prostate cancer screening.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.8. Coverage for Prostate Cancer Screening.--(a)
Except to the extent already covered under another policy, a
health insurance policy shall provide coverage for prostate
cancer screenings for covered individuals in accordance with
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American Cancer Society guidelines for prostate cancer screening
published as of January 1, 2022, and consistent with approved
medical standards and practices. An insurer shall provide
coverage for an annual prostate-specific antigen blood test and
an annual digital rectal examination for a policyholder
identified under subsection (b).
(b) The coverage required under this section shall be
provided for all of the following:
(1) A policyholder who meets all of the following criteria:
(i) The policyholder is a man who is fifty (50) years of age
or older.
(ii) The policyholder is expected to live at least ten (10)
or more years;
(iii) The policyholder is diagnosed by a physician as having
an average risk of prostate cancer.
(iv) The policyholder has been informed by a physician of
the uncertainties, risks and potential benefits of prostate
cancer screenings in accordance with American Cancer Society
guidelines for prostate cancer screening published as of January
1, 2022.
(2) A policyholder who meets all of the following criteria:
(i) The policyholder is a man who is forty-five (45) years
of age or older.
(ii) The policyholder is diagnosed by a physician as having
a high risk of prostate cancer as determined by any of the
following:
(A) The policyholder had one first-degree relative who had
prostate cancer before attaining sixty-five (65) years of age.
(B) The policyholder is African American.
(C) The policyholder has any other indicator of a high risk
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of prostate cancer.
(iii) The policyholder has been informed by a physician of
the uncertainties, risks and potential benefits of prostate
cancer screenings in accordance with American Cancer Society
guidelines for prostate cancer screening published as of January
1, 2022.
(3) A policyholder who meets all of the following criteria:
(i) The policyholder is a man who is forty (40) years of age
or older.
(ii) The policyholder has been diagnosed by a physician as
having a higher risk of prostate cancer by having more than one
first-degree relative who had prostate cancer before attaining
sixty-five (65) years of age.
(iii) The policyholder has been informed by a physician of
the uncertainties, risks and potential benefits of prostate
cancer screenings in accordance with American Cancer Society
guidelines for prostate cancer screening published as of January
1, 2022.
(c) The coverage required under this section shall be
subject to annual deductibles, coinsurance and copayment
requirements imposed by an insurer subject to this section for
similar coverages under the same health insurance policy or
contract.
(d) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection:
"Digital rectal examination" means an internal examination of
the rectum that is performed by a health care provider for the
purpose of identifying body abnormalities.
"First-degree relative" means a father, brother or son.
"Health insurance policy" means a policy, subscriber
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contract, certificate or plan issued by an insurer that provides
medical or health care coverage. The term does not include:
(1) Accident only.
(2) Credit only.
(3) Long-term care or disability income.
(4) Specified disease.
(5) Medicare supplement.
(6) TRICARE, including a Civilian Health and Medical Program
of the Uniformed Services (CHAMPUS) supplement.
(7) Fixed indemnity.
(8) Dental only.
(9) Vision only.
(10) Workers' compensation.
(11) Automobile medical payment under 75 Pa.C.S. (relating
to vehicles).
"Insurer" means an entity licensed by the Insurance
Department with accident and health authority to issue a policy,
subscriber contract, certificate or plan that provides medical
or health care coverage that is offered or governed under any of
the following:
(1) This act, including section 630 and Article XXIV.
(2) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"Prostate cancer screening" means tests and other measures
used to detect prostate cancer that adhere to the American
Cancer Society guidelines on screening for prostate cancer
published as of January 1, 2022.
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"Prostate-specific antigen blood test" means a blood test
that measures the level of prostate-specific antigen in the
blood for the purpose of screening men for the occurrence of
prostate cancer.
Section 2. This act shall take effect in 60 days.
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