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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
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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
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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:
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(1) "Health insurance policy" [means any group health,
sickness or accident policy or subscriber contract or
certificate offered to groups of fifty-one (51) or more employes
issued by an entity subject to any one of the following:
(i) This act.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).] as follows:
(i) A policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage.
(ii) The term does not include accident only, fixed
indemnity, hospital indemnity, limited benefit, credit, dental,
vision, specified disease, Medicare supplement, Civilian Health
and Medical Program of the Uniformed Services (CHAMPUS)
supplement, long-term care or disability income, workers'
compensation or automobile medical payment insurance.
(iii) The term does not include a grandfathered health care
plan as defined in 40 Pa.C.S. § 9103 (relating to definitions).
(2) "Colonoscopy" means an examination of the rectum and the
entire colon using a lighted instrument called a colonoscope.
(3) "Colorectal cancer screening tests" means [any of the
following] procedures that are furnished to an individual for
the purpose of early detection of colorectal cancer, INCLUDING:
(i) Screening fecal-occult blood or fecal immunochemical
test.
(ii) Screening flexible sigmoidoscopy.
(iii) Screening colonoscopy.
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(iv) Screening barium enema.
(v) [Screening test consistent with approved medical
standards and practices to detect colon cancer] CT colonography.
(vi) Multi-target stool DNA test.
(vii) Screening test consistent with approved medical
standards and practices to detect colon cancer.
(VIII) MULTI-TARGET STOOL RNA TEST EVERY THREE (3) YEARS.
(IX) CELL-FREE DNA TEST OR OTHER BLOOD-BASED SCREENING TEST
RECOMMENDED UNDER THE APPROVED MEDICAL GUIDELINES EVERY THREE
(3) YEARS.
(4) "Nonsymptomatic person at high or increased risk" means
an individual who poses a higher than average risk for
colorectal cancer according to the [American Cancer Society
guidelines] U.S. Multi-Society Task Force recommendations on
screening for colorectal cancer as of [January 1, 2008] June 6,
2017.
(5) "Symptomatic person" means an individual who experiences
a change in bowel habits, rectal bleeding [or], persistent
stomach cramps, weight loss [or], abdominal pain or other
symptoms of colorectal cancer.
(6) "Insurer" means an entity licensed by the Insurance
Department that offers, issues or renews an individual or group
health insurance policy that is offered or governed under any of
the following:
(i) This act, including section 630 and Article XXIV.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
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(7) "Direct visualization test" means a sigmoidoscopy,
computed tomography (CT) colonography or any other test that
allows the interior of the colon to be visually observed.
(8) "APPROVED MEDICAL GUIDELINES" MEANS ANY OF THE
FOLLOWING:
(I) AMERICAN CANCER SOCIETY GUIDELINES FOR COLORECTAL CANCER
SCREENING PUBLISHED AS OF MAY 27, 2026.
(II) NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES FOR
COLORECTAL CANCER PUBLISHED AS OF JUNE 24, 2025.
(III) CENTERS FOR MEDICARE AND MEDICAID SERVICES NATIONAL
COVERAGE DETERMINATION 210.3 COLORECTAL CANCER SCREENING TESTS
GUIDELINES PUBLISHED AS OF JANUARY 1, 2023.
Section 2. This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this paragraph.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this paragraph.
Section 3. This act shall take effect in 60 days.
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