PRINTER'S NO. 1638
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1225
Session of
2022
INTRODUCED BY MENSCH, K. WARD, BAKER, BARTOLOTTA, GEBHARD,
LANGERHOLC, MARTIN, PHILLIPS-HILL, STEFANO, TOMLINSON,
J. WARD, COSTA, BOSCOLA, BREWSTER, CAPPELLETTI, COLLETT,
FONTANA, HUGHES, KEARNEY AND TARTAGLIONE, MAY 9, 2022
REFERRED TO BANKING AND INSURANCE, MAY 9, 2022
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.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 632(b) of the act of May 17, 1921
(P.L.682, No.284), known as The Insurance Company Law of 1921,
amended July 1, 2020 (P.L.572, No.52), is amended to read:
Section 632. Coverage for Mammographic Examinations and
Diagnostic Breast Imaging.--* * *
(b) A group or individual health or sickness or accident
insurance policy providing hospital or medical/surgical coverage
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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 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.]; or
(6) extremely dense breast tissue based on breast
20220SB1225PN1638 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
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].
* * *
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.
20220SB1225PN1638 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19