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PRINTER'S NO. 1178
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
595
Session of
2019
INTRODUCED BY MENSCH, SCAVELLO, LAUGHLIN, KILLION, PHILLIPS-
HILL, VOGEL, K. WARD, YAW, STREET, BOSCOLA, BREWSTER,
FARNESE, TARTAGLIONE, COSTA, HUGHES, SANTARSIERO, SCHWANK,
FONTANA, HAYWOOD, BLAKE, LEACH, L. WILLIAMS, MUTH, COLLETT,
IOVINO, KEARNEY, DINNIMAN, AUMENT, BAKER, J. WARD, TOMLINSON
AND BARTOLOTTA, SEPTEMBER 23, 2019
REFERRED TO BANKING AND INSURANCE, SEPTEMBER 23, 2019
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.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 632 of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921, is amended
to read:
Section 632. Coverage for Mammographic Examinations and
Diagnostic Breast Imaging.--(a) All group or individual health
or sickness or accident insurance policies providing hospital or
medical/surgical coverage and all group or individual subscriber
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contracts or certificates issued by any entity subject to 40
Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63
(relating to professional health services plan corporations),
this act, the act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act," the act of July
29, 1977 (P.L.105, No.38), known as 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
(Public Law 93-406, 29 U.S.C. ยง 1001 et seq.) providing hospital
or medical/surgical coverage shall also provide coverage for
mammographic examinations. The minimum coverage required shall
include all costs associated with a mammogram every year for
women 40 years of age or older [and], with any mammogram based
on a physician's recommendation for women under 40 years of age
and diagnostic or supplemental magnetic resonance imaging or, if
such imaging is not possible, ultrasound if recommended by a
licensed physician because the woman is believed to be at an
increased risk for breast cancer due to:
(1) family history or personal history of breast cancer
or prior atypical breast biopsy;
(2) positive genetic testing; or
(3) heterogeneously dense or extremely dense breast
tissue based on the Breast Imaging and Reporting Data System
established by the American College of Radiology.
Prior to payment for a screening mammogram, insurers shall
verify that the screening mammography service provider is
properly licensed by the department in accordance with the act
of July 9, 1992 (P.L.449, No.93), known as the "Mammography
Quality Assurance Act." Nothing in this section shall be
construed to require an insurer to cover the surgical procedure
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known as mastectomy or to prevent application of deductible or
copayment provisions contained in the policy or plan.
(b) This section shall not apply to the following types of
policies:
(1) Accident only.
(2) Limited benefit.
(3) Credit.
(4) Dental.
(5) Vision.
(6) Specified disease.
(7) Medicare supplement.
(8) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(9) Long-term care or disability income.
(10) Workers' compensation.
(11) Automobile medical payment.
Section 2. This act shall take effect in 60 days.
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