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HOUSE AMENDED
PRIOR PRINTER'S NOS. 1178, 1396
PRINTER'S NO. 1722
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,
BARTOLOTTA, REGAN, STEFANO, BROOKS, BROWNE, YUDICHAK,
SABATINA, DiSANTO, ARGALL, A. WILLIAMS, MARTIN, HUTCHINSON,
MASTRIANO AND LANGERHOLC, SEPTEMBER 23, 2019
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, MAY 28, 2020
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
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or sickness or accident insurance policies providing hospital or
medical/surgical coverage and all group or individual subscriber
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 supplemental magnetic resonance imaging or, if such imaging
is not possible, ultrasound if recommended by the treating
physician because the woman is believed to be at an increased
risk for breast cancer due to:
(1) personal history of atypical breast histologies;
(2) personal or family history or genetic predisposition for
breast cancer;
(3) prior therapeutic thoracic radiation therapy;
(4) 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;
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(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 themselves;
(iv) prior therapeutic thoracic radiation therapy between 10
and 30 years of age; or
(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
(5) extremely dense breast tissue based on breast
composition categories of 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
known as mastectomy or to prevent application of deductible or
copayment provisions contained in the policy or plan except as
preempted by Federal Law.
(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
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IMAGING OR, IF SUCH IMAGING IS NOT POSSIBLE, ULTRASOUND IF
RECOMMENDED BY THE TREATING PHYSICIAN 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
(V) PERSONAL HISTORY OF LI-FRAUMENI SYNDROME, COWDEN
SYNDROME OR BANNAYAN-RILEY-RUVALCABA SYNDROME OR A FIRST-DEGREE
RELATIVE WITH ONE OF THESE SYNDROMES.
(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.
(b) (C) This section shall not apply to the following types
of policies:
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(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.
(12) Fixed indemnity.
(13) Hospital indemnity.
Section 2. 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 3. This act shall take effect in 60 days.
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