HB 1123 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, further providing for coverage for colorectal cancer screening.

PRIOR PRINTER'S NO.

1251 PRINTER'STHE NO.GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.

24141123 THE2025 GENERALINTRODUCED ASSEMBLYBY OFGALLAGHER, PENNSYLVANIAJ.HARRIS, HOUSEKHAN, BILLDOUGHERTY, SessionMADDEN, ofHOHENSTEIN, No.GUENST, WARREN, CEPEDA-FREYTIZ, OTTEN,E, CIRESI, SCHLOSSBERG, DONAHUE, McNEILL, SANCHEZ, T.

1123DAVIS, 2025STEELE, INTRODUCEDGREEN, BYFREEMAN, GALLAGHER,CURRY, J.McANDREW, NEILSON, BOROWSKI, CERRATO, RIVERA, MALAGARI, SCOTT, D.

HARRIS,WILLIAMS KHAN,AND DOUGHERTY,O'MARA, MADDEN,APRIL PROBST,3, WAXMAN,2025 GIRAL,REFERRED HILL-EVANS,TO PIELLI,COMMITTEE HANBIDGE,ON CIRESI,INSURANCE, HOHENSTEIN,APRIL GUENST,3, WARREN,2025 CEPEDA-FREYTIZ,AN OTTEN,ACT SCHLOSSBERG,Amending DONAHUE,the McNEILL,act SANCHEZ,of T.May 17, 1921 (P.L.682, No.284), entitled "An act relating to insurance;

DAVIS,amending, STEELE,revising, GREEN,and FREEMAN,consolidating CURRY,the McANDREW,law NEILSON,providing BOROWSKI,for CERRATO,the APRILincorporation 3,of 2025ARI,insurance SCOTT,companies, D.and the regulation, supervision, and 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;

WILLIAMSproviding ANDpenalties; O'MARA, AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF REPRESENTATIVES, AS AMENDED, OCTOBER 7, 2025 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 repealing existing laws," in casualty insurance, further and providing for coverage for colorectal cancer screening.

Coverage for Colorectal Cancer ScreeningScreening.-- TESTS.--(a)(a) [ExceptExcept to the extent already covered under another <-- policy, all health insurance policies as defined in this section shall also]also A HEALTH INSURANCE POLICY OFFERED, ISSUED OR RENEWED <-- IN THIS COMMONWEALTH SHALL provide coverage for colorectal cancer screening TESTS for covered individuals in accordance <-- with American Cancer Society guidelines for colorectal cancer screening published as of [January 1, 2008] May 30, 2018, and consistent with approved medical standards and practices[.] in accordance with the following:

(ii) A sigmoidoscopy, [aa screening barium enema]enema COMPUTED <-- TOMOGRAPHY (CT) COLONOGRAPHY or a test consistent with approved medical standards and practices to detect colon cancer, at least once every five (5) years.

(IV) A MULTI-TARGET STOOL DNA TEST EVERY ONE (1) TO THREE <-- (3) YEARS.

(3) Coverage for nonsymptomatic covered individuals who are at high or increased risk for colorectal cancer who are under [fifty (50)] forty-five (45) years of age shall include a colonoscopy or any combination of colorectal cancer screening tests in accordance with the [AmericanAmerican Cancer Society <--guidelines guidelines]on U.S.screening for colorectal cancer published as of [January 1, 2008] May 30, 2018.

MULTI-SOCIETY(b) TASKThe FORCEcoverage RECOMMENDATIONSrequired onunder <--this screeningsection forshall colorectalbe cancersubject publishedto asannual ofdeductibles, [Januarycoinsurance 1,and 20250HB1123PN2414copayment -requirements 2imposed -by 2008]an Mayentity 30,subject 2018to JUNEthis 6,section 2017.for similar coverages under the same health insurance policy or 20250HB1123PN1251 - 2 - contract.

<-- (4) COVERAGE FOR ALL COVERED INDIVIDUALS SHALL INCLUDE A <-- FOLLOW-UP COLONOSCOPY CONDUCTED AFTER A POSITIVE, NONINVASIVE STOOL-BASED SCREENING TEST OR A DIRECT VISUALIZATION TEST.

(b) The coverage required under [this section shall be <-- subject to] SUBSECTION (A)(1), (3) AND (4) SHALL NOT BE SUBJECT <-- TO COST SHARING, INCLUDING annual deductibles, coinsurance and copayment requirements [imposed by an entity subject to this <-- section for similar coverages under the same health insurance policy or contract].

<-- (B.1) THE COVERAGE REQUIRED UNDER SUBSECTION (A) SHALL BE <-- SUBJECT TO THE FOLLOWING:

(1) ARTICLE XXI OF THIS ACT.

(2) THE TERMS AND CONDITIONS OF THE HEALTH INSURANCE POLICY IF THE TERMS AND CONDITIONS ARE CONSISTENT WITH THIS SECTION.

(3) APPLICABLE FEDERAL LAWS, REGULATIONS AND GUIDANCE.

(B.2) NOTHING IN THIS SECTION SHALL BE CONSTRUED TO:

(1) PRECLUDE AN INSURER FROM APPLYING UTILIZATION REVIEW UNDER ARTICLE XXI OF THIS ACT.

(2) PREVENT THE APPLICATION OF DEDUCTIBLE, COPAYMENT OR COINSURANCE PROVISIONS FOR COLORECTAL CANCER SCREENINGS BEYOND THE MINIMUM COVERAGE REQUIRED UNDER SUBSECTION (A).

(ii) The act of December 29, 1972 (P.L.1701, No.364), known as the "Health Maintenance Organization Act." 20250HB1123PN2414 - 3 - (iii) 40 Pa.C.S.

(ii) The term does not include accident only, fixed indemnity, HOSPITAL INDEMNITY, limited benefit, credit, dental, <-- vision, specified disease, Medicare supplement, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement, long-termlong- term care or disability income, workers' compensation or automobile medical payment insurance.

(III) THE TERM DOES NOT INCLUDE A GRANDFATHERED HEALTH CARE <-- PLAN AS DEFINED IN 40 PA.C.S.

§ 9103 (RELATING TO DEFINITIONS).

(3) "Colorectal cancer screeningscreening" TESTS" means any of the <-- following procedures that are furnished to an individual for the purpose of early detection of colorectal cancer:

20250HB1123PN1251 - 3 - (iv) Screening barium enema.

(4) "Nonsymptomatic person at high or increased risk" means 20250HB1123PN2414 - 4 - an individual who poses a higher than average risk for colorectal cancer according to the [AmericanAmerican Cancer Society <--guidelines guidelines]on U.S.screening for colorectal cancer as of [January 1, 2008] May 30, 2018.

MULTI-SOCIETY(5) TASK"Symptomatic FORCEperson" RECOMMENDATIONSmeans onan <--individual screeningwho forexperiences colorectala cancerchange asin ofbowel [Januaryhabits, 1,rectal 2008]bleeding Mayor 30,persistent <--stomach 2018cramps, JUNEweight 6,loss 2017.or abdominal pain.

<-- (5) "Symptomatic person" means an individual who experiences a change in bowel habits, rectal bleeding [or], persistent <-- stomach cramps, weight loss [or], abdominal pain OR OTHER <-- SYMPTOMS OF COLORECTAL CANCER.

(7) "DIRECT VISUALIZATION TEST" MEANS A SIGMOIDOSCOPY, <-- COMPUTED TOMOGRAPHY (CT) COLONOGRAPHY OR ANY OTHER TEST THAT ALLOWS THE INTERIOR OF THE COLON TO BE VISUALLY OBSERVED.

20250HB1123PN1251 - 4 - (2) For health insurance policies for which neither rates nor forms are required to be filed with the Federal 20250HB1123PN2414 - 5 - 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 paragraph.

20250HB1123PN241420250HB1123PN1251 - 65 -