Pennsylvania SB 88: 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, repealing provisions relating to coverage for mammographic examinations and breast imaging and providing for coverage for mammographic examinations, magnetic resonance imaging and other forms of breast imaging.

Bill Text

PRIOR PRINTER'S NO. 915 PRINTER'S NO. 981
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 88
Session of
2025
INTRODUCED BY FARRY, K. WARD, PENNYCUICK, ROBINSON, BARTOLOTTA,
LAUGHLIN, SANTARSIERO, J. WARD, COSTA, HAYWOOD, FONTANA,
COMITTA, STEFANO, ARGALL, CULVER, HUTCHINSON, BAKER, ROTHMAN,
LANGERHOLC, MASTRIANO, TARTAGLIONE, BROWN, STREET, BROOKS,
SAVAL, PICOZZI, L. WILLIAMS, KANE, PHILLIPS-HILL, FLYNN,
MARTIN, SCHWANK, GEBHARD, KIM, VOGEL, KEARNEY, YAW, BOSCOLA,
HUGHES, COLLETT, PISCIOTTANO, CAPPELLETTI AND MALONE,
JUNE 6, 2025
AS AMENDED ON THIRD CONSIDERATION, JUNE 23, 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
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, repealing
provisions relating to coverage for mammographic examinations
and breast imaging and providing for coverage for
mammographic examinations, magnetic resonance imaging and
other forms of breast imaging.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 632 of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921, is
repealed:
[Section 632. Coverage for Mammographic Examinations and
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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 provide coverage for
mammographic examinations. The minimum coverage required shall
include all costs associated with a mammogram every year for
women 40 years of age or older, with any mammogram based on a
physician's recommendation for women 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 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 40 Pa.C.S. Ch. 61 or 63, this
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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 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 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 the