Pennsylvania 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.

Bill Text

SENATE AMENDED
PRIOR PRINTER'S NOS. 1251, 2414 PRINTER'S NO. 3726
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1123
Session of
2025
INTRODUCED BY GALLAGHER, J. HARRIS, KHAN, DOUGHERTY, MADDEN,
PROBST, WAXMAN, GIRAL, HILL-EVANS, PIELLI, HANBIDGE, CIRESI,
HOHENSTEIN, GUENST, WARREN, CEPEDA-FREYTIZ, OTTEN,
SCHLOSSBERG, DONAHUE, McNEILL, SANCHEZ, T. DAVIS, STEELE,
GREEN, FREEMAN, CURRY, McANDREW, NEILSON, BOROWSKI, CERRATO,
RIVERA, MALAGARI, SCOTT, D. WILLIAMS, O'MARA, KINKEAD, BOYD,
HOGAN, SHAFFER, GUZMAN, K. HARRIS, MADSEN, MARCELL,
KRAJEWSKI, BIZZARRO, SALISBURY AND MULLINS, APRIL 3, 2025
SENATOR GEBHARD, BANKING AND INSURANCE, IN SENATE, AS AMENDED,
JUNE 30, 2026
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 colorectal cancer screening.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 635.3 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 635.3. Coverage for Colorectal Cancer Screening
Tests.--(a) [Except to the extent already covered under another
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

policy, all health insurance policies as defined in this section
shall 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]
APPROVED MEDICAL GUIDELINES, and consistent with approved
medical standards and practices[.] in accordance with the
following:
(1) Coverage for nonsymptomatic covered individuals who are
[fifty (50)] forty-five (45) years of age or older shall
include, but not be limited to:
(i) An annual fecal occult blood test or fecal
immunochemical test.
(ii) A sigmoidoscopy, [a screening barium 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.
(iii) A colonoscopy at least once every ten (10) years.
(iv) A multi-target stool DNA test every one (1) to three
(3) years.
(V) MULTI-TARGET STOOL RNA TEST EVERY THREE (3) YEARS.
(VI) CELL-FREE DNA TEST OR OTHER BLOOD-BASED SCREENING TEST
RECOMMENDED UNDER THE APPROVED MEDICAL GUIDELINES EVERY THREE
(3) YEARS.
(2) Coverage for symptomatic covered individuals shall
include a colonoscopy, sigmoidoscopy or any combination of
colorectal cancer screening tests at a frequency determined by a
treating physician.
(3) Coverage for nonsymptomatic covered individuals who are
20250HB1123PN3726 - 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

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 [American Cancer Society
guidelines] U.S. Multi-Society Task Force recommendations on
screening for colorectal cancer published as of [January 1,
2008] June 6, 2017.
(4) Coverage for all covered individuals shall include a
follow-up colonoscopy conducted after a positive, noninvasive
stool-based STOOL OR BLOOD-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).
(c) For the purpose of this section:
20250HB1123PN3726 - 3 -
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2