PRINTER'S NO. 33
No. 39 Session of 1997
INTRODUCED BY HOLL, JANUARY 15, 1997
REFERRED TO BANKING AND INSURANCE, JANUARY 15, 1997
AN ACT 1 Mandating health insurance coverage for cancer prevention and 2 early detection programs. 3 The General Assembly of the Commonwealth of Pennsylvania 4 hereby enacts as follows: 5 Section 1. Short title. 6 This act shall be known and may be cited as the Cancer 7 Prevention and Early Detection Services Act. 8 Section 2. Declaration of policy. 9 The General Assembly finds and declares as follows: 10 (1) Many cancer prevention and early detection programs 11 are proven to be cost effective and key to reducing cancer 12 morbidity and mortality. 13 (2) Routine examination and screening programs increase 14 the detection of early stage cancers. 15 (3) Early detection of cancer may significantly increase 16 the chance of survival. 17 Section 3. Definitions.
1 The following words and phrases when used in this act shall 2 have the meanings given to them in this section unless the 3 context clearly indicates otherwise: 4 "Health insurance policy." Any individual or group health, 5 sickness or accident policy or subscriber contract or 6 certificate issued by an entity subject to any one of the 7 following: 8 (1) The act of May 17, 1921 (P.L.682, No.284), known as 9 The Insurance Company Law of 1921. 10 (2) The act of December 29, 1972 (P.L.1701, No.364), 11 known as the Health Maintenance Organization Act. 12 (3) The act of May 18, 1976 (P.L.123, No.54), known as 13 the Individual Accident and Sickness Insurance Minimum 14 Standards Act. 15 (4) The act of December 14, 1992 (P.L.835, No.134), 16 known as the Fraternal Benefit Societies Code. 17 (5) 40 Pa.C.S. Ch. 61 (relating to hospital plan 18 corporations) or Ch. 63 (relating to professional health 19 services plan corporations). 20 (6) Medical assistance. 21 Section 4. Mandated coverage. 22 A health insurance policy which is delivered, issued for 23 delivery, renewed, extended or modified in this Commonwealth by 24 a health care insurer shall provide that the health insurance 25 benefits applicable under the policy include a cancer prevention 26 and early detection component that includes, but is not 27 necessarily limited to: 28 (1) Annual gynecological examination, including a pelvic 29 examination and clinical breast examination in accordance 30 with the act of April 22, 1994, (P.L.136, No.20), known as 19970S0039B0033 - 2 -
1 Women's Preventative Health Services Act. 2 (2) Routine pap smears in accordance with the 3 recommendations of the American College of Obstetricians and 4 Gynecologists in accordance with the Women's Preventative 5 Health Services Act. 6 (3) Mammographic examination every year for women 40 7 years of age or older and any mammogram based on a 8 physician's recommendation for women under 40 years of age in 9 accordance with the provisions of section 632 of the act of 10 May 17, 1921 (P.L.682, No.284), known as The Insurance 11 Company Law of 1921. 12 (4) For men 50 years of age or older, an annual digital 13 rectal examination to detect prostate cancer. 14 (5) For men 50 years of age or older, an annual prostate 15 specific antigen (PSA) test as deemed medically necessary. 16 (6) For individuals 50 years of age or older, an annual 17 fecal occult blood test and, every fourth year after an 18 individual reaches 50 years of age, a sigmoidoscopy or other 19 appropriate test to detect colon cancer. 20 Section 5. Delivery of policy. 21 If a health insurance policy provides coverage or benefits to 22 a resident of this Commonwealth, it shall be deemed to be 23 delivered in this Commonwealth within the meaning of this act, 24 regardless of whether the health care insurer issuing or 25 delivering the policy is located within or outside this 26 Commonwealth. 27 Section 6. Repeals. 28 All acts and parts of acts are repealed insofar as they are 29 inconsistent with this act. 30 Section 7. Applicability. 19970S0039B0033 - 3 -
1 This act shall apply to all insurance policies, subscriber 2 contracts and group insurance certificates issued under any 3 group master policy delivered or issued for delivery on or after 4 the effective date of this act only to residents of this 5 Commonwealth. This act shall also apply to all renewals of 6 contracts on any renewal date which is on or after the effective 7 date of this act. 8 Section 8. Effective date. 9 This act shall take effect in 180 days. L6L40BIL/19970S0039B0033 - 4 -