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, providing for coverage for prostate cancer screening.

PRINTER'S NO. 224
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 281
Session of
2025
INTRODUCED BY McNEILL, HARKINS, KHAN, SCHLOSSBERG, CERRATO,
KAZEEM AND OTTEN, JANUARY 22, 2025
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 22, 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, providing
for coverage for prostate cancer screening.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.11. Coverage for Prostate Cancer Screening.--(a)
A health insurance policy offered, issued or renewed in this
Commonwealth shall provide coverage for all expenses associated
with prostate cancer screenings no less than annually for
covered persons who are at least forty years of age and are at
high risk of developing prostate cancer based on one of the
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following factors:
(1) diagnosis of the covered person or a first-degree
relative with a genetic alteration or cancer associated with
increased risk of prostate cancer;
(2) family history of prostate cancer; or
(3) other factors, if a physician determines that early
detection for prostate cancer is medically appropriate.
(b) The coverage required under this section shall not be
subject to cost-sharing.
(c) (1) Except as provided in paragraph (2), the terms in
this section shall be given the same meaning as in section 2102.
(2) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Cost-sharing" means the share of the health care costs
covered by a health insurance policy that a covered person pays
out-of-pocket. The term includes a deductible, coinsurance,
copayment or similar charge. The term does not include a
premium, a balance billed amount from an out-of-network provider
or the cost of a noncovered service.
"Family history of prostate cancer" means that a first-degree
relative of a covered person was diagnosed with, developed or
died as a result of prostate cancer.
"First-degree relative" means a biological parent, full
biological sibling or biological child.
"Prostate cancer screening" includes prostate-specific
antigen tests and digital rectal examinations.
Section 2. This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed by the Federal Government
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or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
180 days 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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