PRINTER'S NO. 64
No. 69 Session of 1999
INTRODUCED BY HOLL, JANUARY 8, 1999
REFERRED TO BANKING AND INSURANCE, JANUARY 8, 1999
AN ACT
1 Mandating health insurance coverage for cancer prevention and
2 early detection programs.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Short title.
6 This act shall be known and may be cited as the Cancer
7 Prevention and Early Detection Services Act.
8 Section 2. Declaration of policy.
9 The General Assembly finds and declares as follows:
10 (1) Many cancer prevention and early detection programs
11 are proven to be cost effective and key to reducing cancer
12 morbidity and mortality.
13 (2) Routine examination and screening programs increase
14 the detection of early stage cancers.
15 (3) Early detection of cancer may significantly increase
16 the chance of survival.
17 Section 3. Definitions.
1 The following words and phrases when used in this act shall
2 have the meanings given to them in this section unless the
3 context clearly indicates otherwise:
4 "Health insurance policy." Any individual or group health,
5 sickness or accident policy or subscriber contract or
6 certificate issued by an entity subject to any one of the
7 following:
8 (1) The act of May 17, 1921 (P.L.682, No.284), known as
9 The Insurance Company Law of 1921.
10 (2) The act of December 29, 1972 (P.L.1701, No.364),
11 known as the Health Maintenance Organization Act.
12 (3) The act of May 18, 1976 (P.L.123, No.54), known as
13 the Individual Accident and Sickness Insurance Minimum
14 Standards Act.
15 (4) The act of December 14, 1992 (P.L.835, No.134),
16 known as the Fraternal Benefit Societies Code.
17 (5) 40 Pa.C.S. Ch. 61 (relating to hospital plan
18 corporations) or Ch. 63 (relating to professional health
19 services plan corporations).
20 (6) Medical assistance.
21 The term does not include accident only, fixed indemnity,
22 limited benefit, credit, dental, vision, specified disease,
23 Medicare supplement, Civilian Health and Medical Program of the
24 Uniformed Services (CHAMPUS) supplement, long-term care or
25 disability income, workers' compensation or automobile medical
26 payment insurance.
27 Section 4. Mandated coverage.
28 A health insurance policy which is delivered, issued for
29 delivery, renewed, extended or modified in this Commonwealth by
30 a health care insurer shall provide that the health insurance
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1 benefits applicable under the policy include a cancer prevention
2 and early detection component that includes, but is not
3 necessarily limited to:
4 (1) Annual gynecological examination, including a pelvic
5 examination and clinical breast examination in accordance
6 with the act of April 22, 1994, (P.L.136, No.20), known as
7 Women's Preventative Health Services Act.
8 (2) Routine pap smears in accordance with the
9 recommendations of the American College of Obstetricians and
10 Gynecologists in accordance with the Women's Preventative
11 Health Services Act.
12 (3) Mammographic examination every year for women 40
13 years of age or older and any mammogram based on a
14 physician's recommendation for women under 40 years of age in
15 accordance with the provisions of section 632 of the act of
16 May 17, 1921 (P.L.682, No.284), known as The Insurance
17 Company Law of 1921.
18 (4) For men 50 years of age or older, an annual digital
19 rectal examination to detect prostate cancer.
20 (5) For men 40 years of age or older with a family
21 history of prostate cancer or other prostate cancer risk
22 factors an annual digital rectal examination to detect
23 prostate cancer.
24 (6) For men 50 years of age or older, an annual prostate
25 specific antigen (PSA) test or a test consistent with
26 approved medical standards and practices, as deemed medically
27 necessary.
28 (7) For men 40 years of age or older with a family
29 history of prostate cancer or other prostate cancer risk
30 factors, an annual prostate specific antigen, or a test
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1 consistent with approved medical standards and practice, as
2 deemed medically necessary.
3 (8) For individuals 50 years of age or older, an annual
4 fecal occult blood test and, every fourth year after an
5 individual reaches 50 years of age, a sigmoidoscopy or a test
6 consistent with approved medical standards and practice to
7 detect colon cancer.
8 Section 5. Copayments and deductibles.
9 (a) Applicability.--The cancer prevention and early
10 detection benefits required under this act shall be subject to
11 the copayment and coinsurance provisions of a health insurance
12 policy to the extent that other medical services covered by the
13 policy are subject to those provisions.
14 (b) Exemption.--The cancer prevention and early detection
15 benefits required under this act shall be exempt from deductible
16 or dollar limit provisions in a health insurance policy. This
17 exemption must be explicitly stated in the policy.
18 Section 6. Delivery of policy.
19 If a health insurance policy provides coverage or benefits to
20 a resident of this Commonwealth, it shall be deemed to be
21 delivered in this Commonwealth within the meaning of this act,
22 regardless of whether the health care insurer issuing or
23 delivering the policy is located within or outside this
24 Commonwealth.
25 Section 7. Repeals.
26 All acts and parts of acts are repealed insofar as they are
27 inconsistent with this act.
28 Section 8. Applicability.
29 This act shall apply to all insurance policies, subscriber
30 contracts and group insurance certificates issued under any
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1 group master policy delivered or issued for delivery on or after
2 the effective date of this act only to residents of this
3 Commonwealth. This act shall also apply to all renewals of
4 contracts on any renewal date which is on or after the effective
5 date of this act.
6 Section 9. Effective date.
7 This act shall take effect in 180 days.
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