Pennsylvania 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.

Bill Text

PRIOR PRINTER'S NO. 406 PRINTER'S NO. 1300
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 433
Session of
2025
INTRODUCED BY CURRY, PIELLI, DONAHUE, FREEMAN, CERRATO, HILL-
EVANS, SANCHEZ, GUENST, GIRAL, GALLAGHER, PROBST, KHAN,
MADDEN, WAXMAN, STEELE, OTTEN, KENYATTA, D. WILLIAMS, MAYES,
KINKEAD, HOHENSTEIN, O'MARA, DEASY, BOYD, BOROWSKI, FIEDLER,
PARKER, SHUSTERMAN, GREEN, NEILSON, RIVERA, CEPEDA-FREYTIZ,
D. MILLER, HANBIDGE, HOWARD, CIRESI, MEHAFFIE, SCHWEYER,
SCHLOSSBERG, MATZIE, SCOTT, CONKLIN AND K.HARRIS,
JANUARY 31, 2025
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, APRIL 8, 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, further
providing for coverage for mammographic examinations and
breast imaging.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. 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:
Section 632. Coverage for Mammographic Examinations and
Breast Imaging.--* * *
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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 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
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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. Ch. 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 coverage] A HEALTH
INSURANCE POLICY OFFERED, ISSUED OR RENEWED IN THIS COMMONWEALTH
shall also provide coverage for breast imaging. The minimum
coverage required shall include all costs associated with [one]
diagnostic breast examinations that are used to evaluate a seen
or suspected abnormality from a screening examination for breast
cancer or used to evaluate an abnormality detected by another
means of examination. 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:
(1) personal history of atypical breast histologies;
(2) personal history or family history of breast cancer;
(3) genetic pred