Mandatory Coverage for Cervical Cancer Screening for Some Insurers, 

Mandatory Offer for Other Insurers (n=1)

Mandatory Coverage for Cervical Cancer Screening (n=26) Coverage Not Required (n=24)

Source:  National Cancer Institute: State Cancer Legislative Database Program,Bethesda,MD,2006

Building 31, Room 10A48 • 31 Center Drive, MSC 2580 • Bethesda, Maryland 20892-2580 • 301 496 5217 • 301 402 1225 fax • http://www.scld-nci.net

The SCLD contains information synthesized from state-level laws. The SCLD does not contain state-level regulations; executive orders; measures implemented 

by counties, cities, or other localities; case law; Attorneys General opinions; or data addressing the implementation of state laws—all of which vary significantly 

from the laws reported herein.

Pelvic exams, Pap tests (also referred to as Pap smears), and 

tests for human papillomavirus (HPV) are essential parts of 

a woman’s routine health examinations because these tests 

can detect cervical cancer or abnormalities that may lead to 

cervical cancer.

In 1987, Massachusetts was the first state to require specific 

third-party insurers to provide coverage for annual cervical 

cancer screening. Currently, 26 states and the District of

Columbia (collectively, “states”) have enacted similar laws. 

New Jersey’s law is unique in requiring certain insurers to 

provide coverage for cervical cancer screening while requiring 

others to offer such coverage. Of the states that require 

screening coverage, California, Georgia, Kansas, Maine, 

New Jersey, New Mexico, and South Carolina specify that 

coverage is dependent upon the recommendation of a health 

care provider. Laws in 26 states specifically mandate coverage 

for Pap tests, while Maryland mandates coverage only for 

HPV testing. Five other states—California, New Mexico, 

North Carolina, Texas, and West Virginia—require that 

cervical cancer screening coverage include reimbursement for 

HPV testing. Eight states explicitly require coverage to include 

a clinical pelvic examination to detect abnormalities. 

State laws that mandate coverage for cervical cancer 

screening often stipulate age and frequency requirements, 

either in the text of the law itself or by requiring coverage to 

conform to the screening guidelines of a specified national 

organization. Missouri, North Carolina, and Rhode Island

require coverage that conforms to the American Cancer 

Society guidelines, which recommend annual screening 

(or biennial if using new liquid-based cervical cytology 

screening) beginning three years after a woman begins 

having vaginal intercourse, but no later than 21 years of age. 

Alternatively, North Carolina allows coverage to conform 

to guidelines established by the North Carolina Advisory 

Committee on Cancer Coordination and Control. Three 

states­—Maryland, Pennsylvania, and Texas—require 

coverage to conform to the guidelines of the American 

College of Obstetricians and Gynecologists (ACOG). In Texas, 

coverage may also conform to the guidelines of a “similar 

national organization.” West Virginia requires coverage 

to conform either to ACOG guidelines or those of the U.S. 

Preventive Services Task Force. Ten of the remaining 20 states 

include age requirements for the initiation of screening: nine 

states specify that screening coverage must begin at age 18, 

and one requires screening coverage to begin at age 20. 

Testing frequency requirements also vary. The laws of 

15 states require annual screening coverage. New Jersey

specifies biennial Pap test coverage only for specified 

individual insurers. Five states—the District of Columbia, 

Georgia, New Jersey, Oregon, and South Carolina—specify 

that coverage for more frequent testing is required if recommended by a physician. Three states—Kansas, Ohio, and 

Wyoming—do not stipulate age or frequency requirements. 

The laws of 13 states provide that screening coverage may 

be subject to insurance co-payments, deductibles, and/or 

coinsurance.

National Cancer Institute

U.S. DEPARTMENT 

OF HEALTH AND 

HUMAN SERVICES

National Institutes 

of Health

Cervical Cancer

State Cancer Legislative Database Fact Sheet December 2006

Office of Policy Analysis and Response

States with Laws Requiring Third-Party Coverage for Cervical Cancer

Screening* (as of September 30, 2006)

*(Applies only to HPV testing in Maryland)
State Laws Requiring Private Third-Party Coverage for Cervical Cancer Screening (as of September 30, 2006)

State Mandatory 

Coverage 

Test(s) Covered Coverage 

must conform 

to specified 

organization’s 

guidelines

Age and Frequency Requirements for Pap Test/Cytology 

Specified in Law Law states that 

copayment/

deductibles/

co-insurance 

may apply

Pap Test/

Cytologic 

Screening

Pelvic/ 

Clinical 

Exams HPV Testing

Age 

requirements Frequency

More frequent 

testing if 

recommended by 

a physician

Alabama

Alaska l l ≥ 18 Annual l

Arizona

Arkansas

California l1 l l2 l Annual l

Colorado

Connecticut

Delaware l l ≥ 18 Annual l

District of Columbia l l Annual l

Florida

Georgia l1 l Annual l l

Hawaii

Idaho

Illinois l l Annual

Indiana

Iowa

Kansas l1 l l

Kentucky

Louisiana l l Annual

Maine l1 l l Annual

Maryland l (HPV

 testing only) l l3 (HPV testing only)

l

(HPV testing only)

Massachusetts l l ≥ 18 Annual

Michigan

Minnesota l l (When ordered or provided by a physician 

according to standard practice)

Mississippi

Missouri l l l l4 l

Montana

Nebraska

Nevada l l ≥ 18 Annual

New Hampshire

New Jersey l1,5 l ≥ 20 Biennial (Individual plans only) l

New Mexico l1 l l l ≥ 18 (Upon determination of health care provider 

according to medical standards) l

New York l l l ≥ 18 Annual l

North Carolina l l l l6 l

North Dakota

Ohio l l

Oklahoma

Oregon l l l 18-64 Annual l

Pennsylvania l l l l3 

Rhode Island l l l4 

South Carolina l1 l Annual l l

South Dakota

Tennessee

Texas l l

l

(in combination 

with Pap test)

l3 

(or similar national 

organization)

≥ 18 Annual

Utah

Vermont

Virginia l l Annual

Washington

West Virginia l l l l3 or 7 ≥ 18 l

Wisconsin

Wyoming l l l l(co-insurance, not 

deductibles)

Key:

1. Coverage is contingent upon recommendation by a health care provider.

2. Although California law does not explicitly address pelvic/clinical exams, Cal. Health & Safety Code § 1367.665 requires third-party reimbursement for “all generally 

medically accepted cancer screening tests.”

3. American College of Obstetricians and Gynecologists (ACOG) Guidelines—Cervical cancer screening should begin within three years after first vaginal intercourse, or 

by age 21, whichever comes first. Guidelines for subsequent screening differ based on age, type of screening test, and prior test results.

4. American Cancer Society (ACS) Guidelines—Cervical cancer screening should begin approximately three years after a woman begins having vaginal intercourse, but no 

later than 21 years of age. Guidelines for subsequent screening differ based on age, type of screening test, and prior test results.

5. New Jersey law stipulates that certain specified HMOs must only offer coverage.

6. Requires coverage to conform to ACS Guidelines or the guidelines established by the North Carolina Advisory Committee on Cancer Coordination and Control.

7. United States Preventive Services Task Force (USPSTF) Recommendations—The USPSTF strongly recommends screening for cervical cancer in women who have been 

sexually active and recommends against routinely screening women older than age 65 or women who have had a total hysterectomy for benign disease.

Note: State administrative regulations are not included in this analysis.

Source: National Cancer Institute: State Cancer Legislative Database Program, Bethesda, MD, 2006