Source: National Cancer Institute: State Cancer Legislative Database Program, Bethesda, MD, 2011

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; opinions of Attorneys General; or data addressing the implementation of state laws—all of which may vary from the laws 

reported here.

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

tests for the human papillomavirus (HPV) are essential parts 

of women’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 only 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. Of these, 

five states—California, New Mexico, North Carolina, Texas, 

and West Virginia—require that cervical cancer screening 

coverage include reimbursement for HPV testing. Six 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. 

Eight of the remaining 21 states include age requirements 

for the initiation of screening. Seven of these states specify 

that screening coverage must begin at age 18 (through age 

64 in Oregon), while New Jersey requires screening coverage 

beginning at age 20.

Testing frequency requirements also vary. The laws of 

14 states require annual screening coverage. New Jersey 

requires biennial Pap test coverage only for specified individual insurers. Five states—the District of Columbia, Georgia, 

New Jersey, Oregon, and South Carolina—mandate 

coverage for more frequent testing if recommended by a 

physician. Five states—Colorado, Kansas, Maine, Ohio, and 

Wyoming—do not stipulate age or frequency requirements. 

Coverage in Minnesota and New Mexico must be recommended by a physician and be based on medical standards.

The laws of 15* states provide that screening coverage may 

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

coinsurance.

*Applies only to HPV testing in Maryland

National Cancer Institute

U.S. DEPARTMENT 

OF HEALTH AND 

HUMAN SERVICES

National Institutes 

of Health

Cervical Cancer Screening

State Cancer Legislative Database Fact Sheet July 2011

Office of Government and Congressional Relations

State Laws Requiring Third-Party Coverage for Cervical Cancer Screening* 

(enacted as of March 31, 2011)

Mandatory Coverage for

Cervical Cancer Screening (n=27)

Mandatory Coverage for

Cervical Cancer Screening for Some Insurers,

Mandatory Offer for Other Insurers (n=1)

Coverage Not Required (n=23)

CA

MD

NJ

RI

OR

NM

CO

WY

NV

AK

KS

TX

MO

LA

MN

IL OH

GA

SC

NC

WV VA

PA

NY

ME

MA

DC

DE
State Laws Requiring Third-Party Coverage for Cervical Cancer Screening

(enacted as of March 31, 2011)

Source: National Cancer Institute: State Cancer Legislative Database Program, Bethesda, MD, 2011.

State

Mandatory 

Coverage

Test(s) Covered Coverage 

Must 

Conform to 

Specified 

Organization’s 

Guidelines

Age and Frequency Requirements for Pap Test/

Cytology Specified in the Law Copayment, 

Deductibles, 

and/or 

Coinsurance 

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 and older Annual l

Arizona

Arkansas

California l1,2 l l Annual l

Colorado l l

Connecticut

Delaware l l 18 and older Annual l

District of Columbia l l Annual l l3

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

Maryland l (HPV 

testing only) l l4 (HPV testing only)

l (HPV 

testing only)

Massachusetts l l 18 and older Annual

Michigan

Minnesota l l When ordered or provided by a physician 

according to standard practice

Mississippi

Missouri l l l l5 l

Montana

Nebraska

Nevada l l 18 and older Annual

New Hampshire

New Jersey l1,6 l 20 and older7 Biennial 

(individual plans only) l

New Mexico l1 l l l 18 and older Upon determination of health care provider 

according to medical standards l

New York l l l 18 and older Annual l

North Carolina l l l l8 l

North Dakota

Ohio l l

Oklahoma

Oregon l l l 18 through 64 Annual l

Pennsylvania l l l l4

Rhode Island l l l5

South Carolina l1 l Annual l l

South Dakota

Tennessee

Texas l l l (in combination 

with Pap test)

l4 (or similar 

organization) 18 and older Annual

Utah

Vermont

Virginia l l Annual

Washington

West Virginia l l l l4 or 9 18 and older l

Wisconsin

Wyoming l l l l

Key:

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

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

screening tests.”

3. Copayment applies only when the insured elects screening by an out-of-network provider in a preferred provider plan.

4. American College of Obstetricians and Gynecologists (ACOG) Guidelines: Cervical cancer screening should begin at age 21. Guidelines for subsequent screening differ based on age, type of screening 

test, and prior test results.

5. 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.

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

7. Age requirements do not apply to specified group insurers.

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

9. 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.