Regular Session 2023-2024 Senate Bill 0008 P.N. 0290

PRINTER'S NO. 290

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

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

[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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