PRINTER'S NO. 1231
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
918
Session of
2017
INTRODUCED BY DINNIMAN, FONTANA, BROWNE, BREWSTER, RAFFERTY,
COSTA, HUGHES, FARNESE, MENSCH AND TARTAGLIONE,
OCTOBER 5, 2017
REFERRED TO BANKING AND INSURANCE, OCTOBER 5, 2017
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 health and accident insurance,
providing for coverage for prostate-specific test.
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-specific Test.--(a) All
health insurance policies as defined in this section shall also
provide coverage as provided in subsections (b) and (c) for a
prostate-specific antigen test for covered individuals under
subsection (b) consistent with approved medical standards and
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practices.
(b) The coverage required under this section shall be
provided for:
(1) Men who are:
(i) Fifty-five (55) years of age or older.
(ii) Expected to live at least ten (10) or more years.
(iii) Diagnosed as having an average risk of prostate
cancer.
(2) Men who are:
(i) Forty-five (45) years of age or older.
(ii) Diagnosed as having a high risk of prostate cancer by
having either:
(A) one first-degree relative who had prostate cancer before
fifty (50) years of age; or
(B) any other indicator of a high risk of prostate cancer.
(3) Men who are diagnosed as having a higher risk of
prostate cancer by having more than one first-degree relative
who had prostate cancer before fifty (50) years of age.
(c) Except as provided in subsection (d), the coverage
required by this section shall include all costs associated with
the administration of the prostate-specific antigen test every
year for covered individuals under subsection (b).
(d) The coverage required under this section shall be
subject to annual deductibles, coinsurance and copayment
requirements imposed by an entity subject to this section for
similar coverages under the same health insurance policy or
contract.
(e) As used in this section:
(1) "First-degree relative" means a father, brother or son.
(2) "Health insurance policy" means an individual or group
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health, sickness or accident policy or subscriber contract or
certificate which provides medical or health care coverage by a
health care facility or licensed health care provider which is
offered by or is governed under any of the following:
(i) This act.
(ii) Subarticle (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the "Human Services Code."
(iii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iv) The act of May 18, 1976 (P.L.123, No.54), known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(v) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
The term shall not include accident only, fixed indemnity,
limited benefit, credit, dental, vision, specified disease,
Medicare supplement, Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement, long-term care or
disability income, workers' compensation or automobile medical
payment insurance.
(3) "Prostate-specific antigen test" means a blood test that
measures the level of prostate-specific antigen in the blood for
the purposes of screening men for the occurrence of prostate
cancer and monitoring men who have been previously diagnosed
with prostate cancer.
Section 2. This act shall take effect in 60 days.
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