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PRINTER'S NO. 290
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
8
Session of
2023
INTRODUCED BY K. WARD, ROBINSON, PENNYCUICK, DiSANTO, PHILLIPS-
HILL, BROOKS, J. WARD, BARTOLOTTA, BROWN, BAKER, TARTAGLIONE,
SCHWANK, ARGALL, LANGERHOLC, COSTA, GEBHARD, BREWSTER,
LAUGHLIN, KANE, FLYNN, VOGEL, COLLETT, DILLON, HUGHES,
MARTIN, MASTRIANO, SANTARSIERO, ROTHMAN, COMITTA,
L. WILLIAMS, YAW, HUTCHINSON, STEFANO, AUMENT, SAVAL, REGAN,
COLEMAN, DUSH, FARRY, CAPPELLETTI AND BOSCOLA,
FEBRUARY 14, 2023
REFERRED TO BANKING AND INSURANCE, FEBRUARY 14, 2023
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, further
providing for coverage for mammographic examinations and
diagnostic breast imaging and providing for coverage for
BRCA-related genetic counseling and genetic testing.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 632 heading and (b) of the act of May 17,
1921 (P.L.682, No.284), known as The Insurance Company Law of
1921, are amended and the section is amended by adding a
subsection to read:
Section 632. Coverage for Mammographic Examinations and
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[Diagnostic] Breast Imaging.--* * *
(b) A group or individual health or sickness or accident
insurance policy providing hospital or medical/surgical coverage
and a group or individual subscriber contract or certificate
issued by any entity subject to 40 Pa.C.S. Ch. 61 or 63, this
act, the "Health Maintenance Organization Act," the "Fraternal
Benefit Society Code" or an employe welfare benefit plan as
defined in section 3 of the Employee Retirement Income Security
Act of 1974 providing hospital or medical/surgical coverage
shall also provide coverage for breast imaging. The minimum
coverage required shall include [supplemental magnetic resonance
imaging or, if such imaging is not possible, ultrasound if
recommended by the treating physician] all costs associated with
one supplemental breast screening every year because the woman
is believed to be at an increased risk of breast cancer due to:
(1) personal history of atypical breast histologies;
(2) personal history or family history of breast cancer;
(3) genetic predisposition for breast cancer;
(4) prior therapeutic thoracic radiation therapy;
(5) heterogeneously dense breast tissue based on breast
composition categories [of the Breast Imaging and Reporting Data
System established by the American College of Radiology] with
any one of the following risk factors:
(i) lifetime risk of breast cancer of greater than 20%,
according to risk assessment tools based on family history;
(ii) personal history of BRCA1 or BRCA2 gene mutations;
(iii) first-degree relative with a BRCA1 or BRCA2 gene
mutation but not having had genetic testing herself;
(iv) prior therapeutic thoracic radiation therapy between 10
and 30 years of age; or
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(v) personal history of Li-Fraumeni syndrome, Cowden
syndrome or Bannayan-Riley-Ruvalcaba syndrome or a first-degree
relative with one of these syndromes[.]; or
(6) extremely dense breast tissue based on breast
composition [categories of the Breast Imaging and Reporting Data
System established by the American College of Radiology. Nothing
in this subsection shall be construed to require an insurer to
cover the surgical procedure known as mastectomy or to prevent
the application of deductible, copayment or coinsurance
provisions contained in the policy or plan.] categories.
Nothing in this subsection shall be construed as to preclude
utilization review as provided under Article XXI of this act or
to prevent the application of deductible, copayment or
coinsurance provisions contained in the policy or plan for
breast imaging in excess of the minimum coverage required.
* * *
(d) As used in this section:
"Supplemental breast screening" means a medically necessary
and clinically appropriate examination of the breast using
either standard or abbreviated magnetic resonance imaging or, if
such imaging is not possible, ultrasound if recommended by the
treating physician to screen for breast cancer when there is no
abnormality seen or suspected in the breast.
Section 2. The act is amended by adding a section to read:
Section 633.1. Coverage for BRCA-related Genetic Counseling
and Genetic Testing.--(a) A health insurance policy offered,
issued or renewed in this Commonwealth shall provide coverage
for BRCA-related genetic counseling and genetic testing provided
by an individual licensed, certified or otherwise regulated to
provide genetic counseling and genetic testing under the laws of
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this Commonwealth. The minimum coverage required shall include
all costs associated with genetic counseling and, if indicated
after genetic counseling, a genetic laboratory test of the BRCA1
and BRCA2 genes for individuals assessed to be at an increased
risk, based on a clinical risk assessment tool, of potentially
harmful mutations in the BRCA1 or BRCA2 genes due to a personal
or family history of breast or ovarian cancer.
(b) As used in this section:
"Genetic counseling" means the provision of services to
individuals, couples, families and organizations by one or more
appropriately trained individuals to address the physical and
psychological issues associated with the occurrence or risk of
occurrence of a genetic disorder, birth defect or genetically
influenced condition or disease in an individual or a family.
"Health insurance policy" means an individual or group
insurance policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage, including emergency services. The term does not
include any of the following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A fixed indemnity policy.
(7) A hospital indemnity policy.
(8) A dental only policy.
(9) A vision only policy.
(10) A worker's compensation policy.
(11) An automobile medical payment policy.
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(12) A TRICARE policy, including a Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS) supplement
policy.
(13) Any other similar policy providing for limited
benefits.
"Insurer" means an entity licensed by the Insurance
Department with accident and health authority to issue a health
insurance policy 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).
Section 3. This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this section.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this section.
Section 4. This act shall take effect in 60 days.
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