HB 433 — 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 mammographic examinations and breast imaging.

PRIOR PRINTER'S NO.

406 THEPRINTER'S GENERALNO. ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.

1300 THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.

WILLIAMS, MAYES, KINKEAD, HOHENSTEIN, O'MARA, DEASY, BOYD, BOROWSKI, FIEDLER, PARKER, SHUSTERMAN, GREENGREEN, NEILSON, RIVERA, CEPEDA-FREYTIZ, SCHLOSSBERG, MATZIE, SCOTT, CONKLIN AND NEILSON,K.HARRIS,HWEYER, JANUARY 31, 2025 REFERREDAS TOREPRESENTATIVES, COMMITTEEAS ONAMENDED, INSURANCE,APRIL JANUARY8, 31,2025E 2025OF AN ACT Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An consolidatingact therelating lawto providinginsurance; 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;

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, the State Workmen's Insurance Fund;

Section 632(b) and (d) of the act of May 17, 1921 <-- (P.L.682, No.284), known as The Insurance Company Law of 1921, are amended to read:

Coverage for Mammographic Examinations and Breast Imaging.--* * * (b)SECTION A1. 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 Article XXIV, 40 Pa.C.S.

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 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 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.

§ 1001 ET SEQ.) PROVIDING HOSPITAL OR MEDICAL/SURGICAL COVERAGE SHALL ALSO] A HEALTH INSURANCE POLICY OFFERED, ISSUED OR RENEWED IN THIS COMMONWEALTH SHALL PROVIDE COVERAGE FOR MAMMOGRAPHIC EXAMINATIONS.

THE MINIMUM COVERAGE REQUIRED SHALL INCLUDE ALL COSTS ASSOCIATED WITH A MAMMOGRAM EVERY YEAR FOR [WOMEN] INDIVIDUALS 40 YEARS OF AGE OR OLDER, WITH ANY MAMMOGRAM BASED ON A PHYSICIAN'S RECOMMENDATION FOR [WOMEN] INDIVIDUALS UNDER 40 YEARS OF AGE.

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 20250HB0433PN1300 - 2 - 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 Article XXIV, 40 Pa.C.S.

61 or 63, this act, the ["Health Maintenance Organization Act," <-- the "Fraternal Benefit Society Code"] "Health Maintenance <-- Organization Act" 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 coveragecoverage] A HEALTH <-- INSURANCE POLICY OFFERED, ISSUED OR RENEWED IN THIS COMMONWEALTH shall also provide coverage for breast imaging.

The minimum coverage REQUIRED shall also <-- include all costs associated with supplemental breast [screening every year] screenings because the [woman] person INDIVIDUAL is <-- believed to be at an increased risk of breast cancer due to:

20250HB0433PN1300 - 3 - (ii) personal history of BRCA1 or BRCA2 gene mutations;

or 20250HB0433PN0406 - 2 - (v) personal history of Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome or a first-degree relative with one of these syndromes;

* * * <-- (d) As used in this section:

"Diagnostic[(C) breastTHIS examination"SECTION meansSHALL aNOT medicallyAPPLY necessaryTO andTHE clinicallyFOLLOWING appropriateTYPES examinationOF of<-- thePOLICIES: breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound when there is an abnormality seen or suspected.

(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.

20250HB0433PN1300 - 4 - (11) AUTOMOBILE MEDICAL PAYMENT.

(12) FIXED INDEMNITY.

(13) HOSPITAL INDEMNITY.] (D) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2), THE TERMS IN THIS SECTION SHALL BE GIVEN THE SAME MEANING AS IN SECTION 2102 OF THIS ACT.

(2) AS USED IN THIS SECTION[:] THE FOLLOWING WORDS AND PHRASES SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS PARAGRAPH UNLESS THE CONTEXT CLEARLY INDICATES OTHERWISE:

"ALL COSTS" MEANS ALL DEDUCTIBLES, COINSURANCE, COPAYMENTS OR SIMILAR OUT-OF-POCKET EXPENSES PAID OUT-OF-POCKET BY THE INDIVIDUAL RECEIVING A SERVICE.

"Diagnostic breast examination" means a medically necessary and clinically appropriate examination of the breast using diagnostic mammography, EITHER STANDARD OR ABBREVIATED breast <-- magnetic resonance imaging or breast ultrasound when there is an abnormality seen or suspected.

SectionSECTION 2.

THE AMENDMENT OF SECTION 632 OF THE ACT SHALL <-- APPLY AS FOLLOWS: