PRINTER'S NO. 2478
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1944
Session of
2024
INTRODUCED BY CURRY, McNEILL, DONAHUE, FREEMAN, HANBIDGE, KHAN,
HILL-EVANS, SANCHEZ, CEPEDA-FREYTIZ, PROBST, GIRAL,
SCHLOSSBERG, CIRESI, BOROWSKI, MUNROE, MALAGARI, PARKER,
BULLOCK, WEBSTER, McCLINTON, DALEY, FIEDLER, GREEN AND
O'MARA, JANUARY 9, 2024
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 9, 2024
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
breast imaging.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 632(b) and (d) of the act of May 17, 1921
(P.L.682, No.284), known as The Insurance Company Law of 1921,
amended or added May 1, 2023 (P.L.1, No.1), are amended to read:
Section 632. Coverage for Mammographic Examinations and
Breast Imaging.--* * *
(b) A group or individual health or sickness or accident
insurance policy providing hospital or medical/surgical coverage
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and a group or individual subscriber contract or certificate
issued by any entity subject to Article XXIV, 40 Pa.C.S. Ch. 61
or 63, this act, the ["Health Maintenance Organization Act,"
the "Fraternal Benefit Society Code"] "Health Maintenance
Organization Act" 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 all costs associated with [one]
diagnostic breast examinations that are used to evaluate a seen
or suspected abnormality from a screening examination for breast
cancer or used to evaluate an abnormality detected by another
means of examination. The minimum coverage shall also include
all costs associated with supplemental breast [screening every
year] screenings 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 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.
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:
"Diagnostic breast examination" means a medically necessary
and clinically appropriate examination of the breast using
diagnostic mammography, breast magnetic resonance imaging or
breast ultrasound when there is an abnormality seen or
suspected.
"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. This act shall take effect in 60 days.
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