PRINTER'S NO. 257
No. 231 Session of 1989
INTRODUCED BY DURHAM, ITKIN, TIGUE, OLASZ, FREEMAN, FLICK,
MICHLOVIC, DEMPSEY, FOX, SAURMAN, HAYES, KENNEY, MILLER,
BARLEY, JOHNSON, DeLUCA, MRKONIC, BATTISTO, McHALE, KOSINSKI,
J. L. WRIGHT, LASHINGER, B. D. CLARK, NAHILL, VEON, TRELLO,
MARKOSEK, CIVERA, SALOOM, BLACK, KUKOVICH, PETRONE,
E. Z. TAYLOR, FARMER, BELFANTI, HECKLER, SERAFINI, RAYMOND,
KASUNIC, BELARDI AND MAINE, FEBRUARY 1, 1989
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 1, 1989
AN ACT
1 Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2 act relating to insurance; amending, revising, and
3 consolidating the law providing for the incorporation of
4 insurance companies, and the regulation, supervision, and
5 protection of home and foreign insurance companies, Lloyds
6 associations, reciprocal and inter-insurance exchanges, and
7 fire insurance rating bureaus, and the regulation and
8 supervision of insurance carried by such companies,
9 associations, and exchanges, including insurance carried by
10 the State Workmen's Insurance Fund; providing penalties; and
11 repealing existing laws," further providing for coverage of
12 baseline and screening mammograms.
13 The General Assembly of the Commonwealth of Pennsylvania
14 finds that in Pennsylvania breast cancer is the leading cause of
15 cancer deaths among women, and that nationwide, one in ten women
16 will develop breast cancer at some time during her life. In
17 order to protect the health and welfare of women in
18 Pennsylvania, the General Assembly believes there should be
19 insurance coverage to provide early detection of breast cancer
20 and to prevent it from taking anyone's life. For this reason,
1 the General Assembly believes it is necessary for insurance
2 coverage of baseline and screening mammograms.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. The act of May 17, 1921 (P.L.682, No.284), known
6 as The Insurance Company Law of 1921, is amended by adding a
7 section to read:
8 Section 631. Additional Mandated Policy Coverages.--(a)
9 Coverage for baseline and screening mammograms as set forth in
10 subsection (b) shall be provided under the following policies:
11 (1) Group health or sickness or accident insurance policies
12 which provide hospital or medical/surgical coverage.
13 (2) Group subscriber contracts or certificates issued by an
14 entity which provides hospital or medical/surgical coverage and
15 which is subject to any of the following:
16 (i) This act.
17 (ii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
18 corporations) or 63 (relating to professional health services
19 plan corporations).
20 (iii) The act of December 29, 1972 (P.L.1701, No.364), known
21 as the "Health Maintenance Organization Act."
22 (iv) The act of July 29, 1977 (P.L.105, No.38), known as the
23 "Fraternal Benefit Society Code."
24 (b) The minimum coverage required under subsection (a) shall
25 include all costs associated with the following:
26 (1) A baseline mammogram for women forty (40) to forty-nine
27 (49) years of age, inclusive. Annual screening mammograms shall
28 be covered based on physician's recommendations.
29 (2) A screening mammogram for women fifty (50) years of age
30 or older every year.
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1 (c) Reasonable deductible or copayment plans may be applied
2 to benefits paid to or on behalf of patients if contained in the
3 policy or plan. If not contained in the policy or plan, a
4 reasonable deductible or copayment plan must be approved by the
5 Insurance Commissioner. No deductible or copayment shall be less
6 favorable than those applied to similar classes or categories of
7 treatment for physical illness generally in each policy or plan.
8 (d) Nothing in this section shall serve to diminish the
9 benefits of an insured or subscriber existing on the effective
10 date of this act nor prevent the offering or acceptance of
11 benefits which exceed the minimum benefits required by this act.
12 (e) This section shall be applicable to all policies issued
13 or renewed on or after the effective date of this section.
14 Section 2. This act shall take effect immediately.
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