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.

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 predisposition for breast cancer;
(4) prior therapeutic thoracic radiation therapy;
(5) heterogeneously dense breast tissue based on breast
composition categories with any one of the following risk
factors:
(i) lifetime risk of breast cancer of greater than 20%,
according to risk assessment tools based on family history;
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(ii) personal history of BRCA1 or BRCA2 gene mutations;
(iii) first-degree relative with a BRCA1 or BRCA2 gene
mutation but not having had genetic testing herself;
(iv) prior therapeutic thoracic radiation therapy between 10
and 30 years of age; or
(v) personal history of Li-Fraumeni syndrome, Cowden
syndrome or Bannayan-Riley-Ruvalcaba syndrome or a first-degree
relative with one of these syndromes; or
(6) extremely dense breast tissue based on breast
composition categories.
Nothing in this subsection shall be construed as to preclude
utilization review as provided under Article XXI of this act or
to prevent the application of deductible, copayment or
coinsurance provisions contained in the policy or plan for
breast imaging in excess of the minimum coverage required.
* * *
(d) As used in this section:
[(C) THIS SECTION SHALL NOT APPLY TO THE FOLLOWING TYPES OF
POLICIES:
(1) ACCIDENT ONLY.
(2) LIMITED BENEFIT.
(3) CREDIT.
(4) DENTAL.
(5) VISION.
(6) SPECIFIED DISEASE.
(7) MEDICARE SUPPLEMENT.
(8) CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED
SERVICES (CHAMPUS) SUPPLEMENT.
(9) LONG-TERM CARE OR DISABILITY INCOME.
(10) WORKERS' COMPENSATION.
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(11) AUTOMOBILE MEDICAL PAYMENT.
(12) FIXED INDEMNITY.
(13) HOSPITAL INDEMNITY.]
(D) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2), THE TERMS IN
THIS SECTION SHALL BE GIVEN THE SAME MEANING AS IN SECTION 2102
OF THIS ACT.
(2) AS USED IN THIS SECTION[:] THE FOLLOWING WORDS AND
PHRASES SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS PARAGRAPH
UNLESS THE CONTEXT CLEARLY INDICATES OTHERWISE:
"ALL COSTS" MEANS ALL DEDUCTIBLES, COINSURANCE, COPAYMENTS OR
SIMILAR OUT-OF-POCKET EXPENSES PAID OUT-OF-POCKET BY THE
INDIVIDUAL RECEIVING A SERVICE.
"Diagnostic breast examination" means a medically necessary
and clinically appropriate examination of the breast using
diagnostic mammography, EITHER STANDARD OR ABBREVIATED breast
magnetic resonance imaging or breast ultrasound when there is an
abnormality seen or suspected.
"Supplemental breast screening" means a medically necessary
and clinically appropriate examination of the breast using
either standard or abbreviated magnetic resonance imaging or, if
such imaging is not possible, ultrasound if recommended by the
treating physician to screen for breast cancer when there is no
abnormality seen or suspected in the breast.
SECTION 2. THE AMENDMENT OF SECTION 632 OF THE 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, THE AMENDMENT OF SECTION 632 OF
THE ACT SHALL APPLY TO ANY POLICY FOR WHICH A FORM OR RATE IS
FIRST FILED ON OR AFTER THE EFFECTIVE DATE OF THIS SECTION.
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(2) FOR HEALTH INSURANCE POLICIES FOR WHICH NEITHER
RATES NOR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL
GOVERNMENT OR THE INSURANCE DEPARTMENT, THE AMENDMENT OF
SECTION 632 OF THE ACT SHALL APPLY TO ANY POLICY ISSUED OR
RENEWED ON OR AFTER 180 DAYS AFTER THE EFFECTIVE DATE OF THIS
SECTION.
Section 2 3. This act shall take effect in 60 days.
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