I 

111TH CONGRESS 

1ST SESSION H. R. 995 

To amend the Public Health Service Act and Employee Retirement Income 

Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for annual screening mammography for women 40 years of age or older and for such 

screening and annual magnetic resonance imaging for women at high 

risk for breast cancer if the coverage or plans include coverage for 

diagnostic mammography for women 40 years of age or older. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 11, 2009 

Mr. NADLER of New York (for himself, Mr. ACKERMAN, Mr. BISHOP of Georgia, Mr. BISHOP of New York, Ms. BORDALLO, Mrs. CAPPS, Mrs. 

CHRISTENSEN, Mr. CLEAVER, Mr. COHEN, Ms. EDWARDS of Maryland, 

Mr. FRANK of Massachusetts, Mr. GRIJALVA, Mr. HONDA, Ms. KAPTUR, 

Mr. KUCINICH, Ms. LEE of California, Mrs. MALONEY, Mr. MICHAUD, 

Mrs. NAPOLITANO, Ms. NORTON, Ms. SCHAKOWSKY, Mr. SERRANO, Mr. 

SIRES, Ms. SUTTON, Ms. ROS-LEHTINEN, Ms. WASSERMAN SCHULTZ, 

and Mr. SCOTT of Virginia) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committee on Education and Labor, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that 

group and individual health insurance coverage and 

group health plans provide coverage for annual screening 

mammography for women 40 years of age or older and 

for such screening and annual magnetic resonance imagVerDate Nov 24 2008 05:44 Feb 13, 2009 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H995.IH H995

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ing for women at high risk for breast cancer if the 

coverage or plans include coverage for diagnostic mammography for women 40 years of age or older. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Mammogram and MRI Availability Act of 2009’’. 

6 (b) FINDINGS.—Congress finds the following: 

7 (1) An estimated 211,000 women will have been 

8 diagnosed with breast cancer and an estimated 

9 40,000 women will have died from breast cancer 

10 during 2005. 

11 (2) Breast cancer is the second leading cause of 

12 death for women in the United States and is the 

13 leading cause of death for women between the ages 

14 of 40 and 49 in the United States. 

15 (3) Breast cancer death rates were reduced by 

16 24 percent from 1990 to 2000. 

17 (4) A study sponsored by the National Cancer 

18 Institute and published on October 27, 2005, con19 cluded that up to 65 percent of the reduction in the 

20 number of breast cancer deaths was directly attrib21 utable to screening mammography. 

22 (5) An expert panel convened by the National 

23 Institutes of Health’s National Cancer Institute recVerDate Nov 24 2008 05:44 Feb 13, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H995.IH H995

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1 ommended on February 21, 2002, that women be2 tween the ages of 40 and 49 should be screened 

3 every one to two years with mammography. 

4 (6) The American Cancer Society recommends 

5 that women over the age of 40 receive an annual 

6 mammogram. 

7 (7) The American Cancer Society, after review8 ing research since 2002, urges that women at high 

9 risk for breast cancer receive annual magnetic reso10 nance imaging in addition to a mammogram because 

11 such imaging may detect small tumors not found by 

12 a mammogram. 

13 SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOG14 RAPHY UNDER GROUP HEALTH PLANS. 

15 (a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 

16 (1) Subpart 2 of part A of title XXVII of the 

17 Public Health Service Act is amended by adding at 

18 the end the following new section: 

19 ‘‘SEC. 2708. STANDARDS RELATING TO BENEFITS FOR 

20 SCREENING MAMMOGRAPHY AND MAGNETIC 

21 RESONANCE IMAGING. 

22 ‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL

23 SCREENING MAMMOGRAPHY AND ANNUAL MAGNETIC

24 RESONANCE IMAGING.— 


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1 ‘‘(1) IN GENERAL.—A group health plan, and a 

2 health insurance issuer offering group health insur3 ance coverage, that provides coverage for diagnostic 

4 mammography for any woman who is 40 years of 

5 age or older shall provide coverage for annual 

6 screening mammography for such a woman and di7 agnostic mammography, annual screening mammog8 raphy, and annual magnetic resonance imaging for 

9 any high risk woman under terms and conditions 

10 that are not less favorable than the terms and condi11 tions for coverage of diagnostic mammography for a 

12 woman who is 40 years of age or older. 

13 ‘‘(2) DEFINITIONS.—For purposes of this sec14 tion— 

15 ‘‘(A) The term ‘diagnostic mammography’ 

16 means a radiologic procedure that is medically 

17 necessary for the purpose of diagnosing breast 

18 cancer and includes a physician’s interpretation 

19 of the results of the procedure. 

20 ‘‘(B) The term ‘high risk woman’ means a 

21 woman who— 

22 ‘‘(i) has a known BRCA1 or BRCA2 

23 gene mutation; 

24 ‘‘(ii) has a mother, father, brother, 

25 sister, or child with such a gene mutation 


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1 and has not had genetic testing to deter2 mine the existence of such a gene muta3 tion; 

4 ‘‘(iii) has a lifetime risk of breast can5 cer of 20 percent or greater, according to 

6 risk assessment tools that are based main7 ly on family history; 

8 ‘‘(iv) had radiation therapy to the 

9 chest when the woman was between the 

10 ages of 10 and 30 years of age; 

11 ‘‘(v) has Li-Fraumeni syndrome, 

12 Cowden syndrome, or Bannayan-Riley13 Ruvalcaba syndrome, or has a relative de14 scribed in clause (ii) who has one of such 

15 syndromes; or 

16 ‘‘(vi) has another predisposing condi17 tion, as determined by a physician, that 

18 significantly increases the risk of the 

19 woman contracting breast cancer. 

20 ‘‘(C) The term ‘screening mammography’ 

21 means a radiologic procedure provided to a 

22 woman for the purpose of early detection of 

23 breast cancer and includes a physician’s inter24 pretation of the results of the procedure. 


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1 ‘‘(b) PROTECTIONS.—A group health plan, and a 

2 health insurance issuer offering group health insurance 

3 coverage in connection with a group health plan, may 

4 not— 

5 ‘‘(1) deny coverage for annual screening mam6 mography or annual magnetic resonance imaging on 

7 the basis that the coverage is not medically nec8 essary or on the basis that the screening mammog9 raphy or magnetic resonance imaging, respectively, 

10 is not pursuant to a referral, consent, or rec11 ommendation by any health care provider; 

12 ‘‘(2) deny to a woman eligibility, or continued 

13 eligibility, to enroll or to renew coverage under the 

14 terms of the plan, solely for the purpose of avoiding 

15 the requirements of this section; 

16 ‘‘(3) provide monetary payments or rebates to 

17 women to encourage such women to accept less than 

18 the minimum protections available under this sec19 tion; 

20 ‘‘(4) penalize or otherwise reduce or limit the 

21 reimbursement of an attending provider because 

22 such provider provided care to an individual partici23 pant or beneficiary in accordance with this section; 

24 or 


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1 ‘‘(5) provide incentives (monetary or otherwise) 

2 to an attending provider to induce such provider to 

3 provide care to an individual participant or bene4 ficiary in a manner inconsistent with this section. 

5 ‘‘(c) RULES OF CONSTRUCTION.— 

6 ‘‘(1) Nothing in this section shall be construed 

7 to require a woman who is a participant or bene8 ficiary to undergo annual screening mammography 

9 or annual magnetic resonance imaging. 

10 ‘‘(2) This section shall not apply with respect to 

11 any group health plan, or any group health insur12 ance coverage offered by a health insurance issuer, 

13 which does not provide benefits for diagnostic mam14 mography. 

15 ‘‘(3) Nothing in this section shall be construed 

16 as preventing a group health plan or issuer from im17 posing deductibles, coinsurance, or other cost-shar18 ing in relation to benefits for screening mammog19 raphy or magnetic resonance imaging under the plan 

20 (or under health insurance coverage offered in con21 nection with a group health plan), except that such 

22 coinsurance or other cost-sharing for any portion of 

23 such benefits may not be greater than such coinsur24 ance or cost-sharing that is otherwise applicable with 

25 respect to benefits for diagnostic mammography. 


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1 ‘‘(4) Women should (but are not required to) 

2 consult with appropriate health care practitioners 

3 before undergoing screening mammography or mag4 netic resonance imaging, but nothing in this section 

5 shall be construed as requiring the approval of a 

6 health care practitioner before a woman undergoes 

7 an annual screening mammography or annual mag8 netic resonance imaging. 

9 ‘‘(d) NOTICE.—A group health plan under this part 

10 shall comply with the notice requirement under section 

11 715(d) of the Employee Retirement Income Security Act 

12 of 1974 with respect to the requirements of this section 

13 as if such section applied to such plan. 

14 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.— 

15 Nothing in this section shall be construed to prevent a 

16 group health plan or a health insurance issuer offering 

17 group health insurance coverage from negotiating the level 

18 and type of reimbursement with a provider for care pro19 vided in accordance with this section. 

20 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR21 ANCE COVERAGE IN CERTAIN STATES.— 

22 ‘‘(1) SCREENING MAMMOGRAPHY.—The re23 quirements of this section, with respect to annual 

24 screening mammography, shall not apply with re25 spect to health insurance coverage for women who 


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1 are 40 years of age or older or who are high risk 

2 women if there is a State law (as defined in section 

3 2723(d)(1)) for a State that regulates such cov4 erage, that requires coverage to be provided for an5 nual screening mammography for women who are 40 

6 years of age or older or who are high risk women 

7 (as defined in subsection (a)(2)(B)), respectively, 

8 and that provides at least the protections described 

9 in subsection (b). 

10 ‘‘(2) MAGNETIC RESONANCE IMAGING.—The re11 quirements of this section, with respect to annual 

12 magnetic resonance imaging, shall not apply with re13 spect to health insurance coverage if there is a State 

14 law (as defined in section 2723(d)(1)) for a State 

15 that regulates such coverage, that requires coverage 

16 to be provided for annual magnetic resonance imag17 ing for high risk women (as defined in subsection 

18 (a)(2)(B)), and that provides at least the protections 

19 described in subsection (b). 

20 ‘‘(3) CONSTRUCTION.—Section 2723(a)(1) shall 

21 not be construed as superseding a State law de22 scribed in paragraph (1) or (2).’’. 

23 (2) Section 2723(c) of such Act (42 U.S.C. 

24 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

25 and inserting ‘‘sections 2704 and 2708’’. 


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1 (b) ERISA AMENDMENTS.— 

2 (1) Subpart B of part 7 of subtitle B of title 

3 I of the Employee Retirement Income Security Act 

4 of 1974 is amended by adding at the end the fol5 lowing new section: 

6 ‘‘SEC. 715. STANDARDS RELATING TO BENEFITS FOR 

7 SCREENING MAMMOGRAPHY AND MAGNETIC 

8 RESONANCE IMAGING. 

9 ‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL

10 SCREENING MAMMOGRAPHY AND ANNUAL MAGNETIC

11 RESONANCE IMAGING.— 

12 ‘‘(1) IN GENERAL.—A group health plan, and a 

13 health insurance issuer offering group health insur14 ance coverage, that provides coverage for diagnostic 

15 mammography for any woman who is 40 years of 

16 age or older shall provide coverage for annual 

17 screening mammography for such a woman and di18 agnostic mammography, annual screening mammog19 raphy, and annual magnetic resonance imaging for 

20 any high risk woman under terms and conditions 

21 that are not less favorable than the terms and condi22 tions for coverage of diagnostic mammography for a 

23 woman who is 40 years of age or older. 

24 ‘‘(2) DEFINITIONS.—For purposes of this sec25 tion— 


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1 ‘‘(A) The term ‘diagnostic mammography’ 

2 means a radiologic procedure that is medically 

3 necessary for the purpose of diagnosing breast 

4 cancer and includes a physician’s interpretation 

5 of the results of the procedure. 

6 ‘‘(B) The term ‘high risk woman’ means a 

7 woman who— 

8 ‘‘(i) has a known BRCA1 or BRCA2 

9 gene mutation; 

10 ‘‘(ii) has a mother, father, brother, 

11 sister, or child with such a gene mutation 

12 and has not had genetic testing to deter13 mine the existence of such a gene muta14 tion; 

15 ‘‘(iii) has a lifetime risk of breast can16 cer of 20 percent or greater, according to 

17 risk assessment tools that are based main18 ly on family history; 

19 ‘‘(iv) had radiation therapy to the 

20 chest when the woman was between the 

21 ages of 10 and 30 years of age; 

22 ‘‘(v) has Li-Fraumeni syndrome, 

23 Cowden syndrome, or Bannayan-Riley24 Ruvalcaba syndrome, or has a relative deVerDate Nov 24 2008 05:44 Feb 13, 2009 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H995.IH H995

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1 scribed in clause (ii) who has one of such 

2 syndromes; or 

3 ‘‘(vi) has another predisposing condi4 tion, as determined by a physician, that 

5 significantly increases the risk of the 

6 woman contracting breast cancer. 

7 ‘‘(C) The term ‘screening mammography’ 

8 means a radiologic procedure provided to a 

9 woman for the purpose of early detection of 

10 breast cancer and includes a physician’s inter11 pretation of the results of the procedure. 

12 ‘‘(b) PROTECTIONS.—A group health plan, and a 

13 health insurance issuer offering group health insurance 

14 coverage in connection with a group health plan, may 

15 not— 

16 ‘‘(1) deny coverage described in subsection 

17 (a)(1) on the basis that the coverage is not medically 

18 necessary or on the basis that the screening mam19 mography or magnetic resonance imaging is not pur20 suant to a referral, consent, or recommendation by 

21 any health care provider; 

22 ‘‘(2) deny to a woman eligibility, or continued 

23 eligibility, to enroll or to renew coverage under the 

24 terms of the plan, solely for the purpose of avoiding 

25 the requirements of this section; 


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1 ‘‘(3) provide monetary payments or rebates to 

2 women to encourage such women to accept less than 

3 the minimum protections available under this sec4 tion; 

5 ‘‘(4) penalize or otherwise reduce or limit the 

6 reimbursement of an attending provider because 

7 such provider provided care to an individual partici8 pant or beneficiary in accordance with this section; 

9 or 

10 ‘‘(5) provide incentives (monetary or otherwise) 

11 to an attending provider to induce such provider to 

12 provide care to an individual participant or bene13 ficiary in a manner inconsistent with this section. 

14 ‘‘(c) RULES OF CONSTRUCTION.— 

15 ‘‘(1) Nothing in this section shall be construed 

16 to require a woman who is a participant or bene17 ficiary to undergo annual screening mammography 

18 or annual magnetic resonance imaging. 

19 ‘‘(2) This section shall not apply with respect to 

20 any group health plan, or any group health insur21 ance coverage offered by a health insurance issuer, 

22 which does not provide benefits for diagnostic mam23 mography. 

24 ‘‘(3) Nothing in this section shall be construed 

25 as preventing a group health plan or issuer from imVerDate Nov 24 2008 05:44 Feb 13, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H995.IH H995

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1 posing deductibles, coinsurance, or other cost-shar2 ing in relation to benefits for screening mammog3 raphy or magnetic resonance imaging under the plan 

4 (or under health insurance coverage offered in con5 nection with a group health plan), except that such 

6 coinsurance or other cost-sharing for any portion of 

7 such benefits may not be greater than such coinsur8 ance or cost-sharing that is otherwise applicable with 

9 respect to benefits for diagnostic mammography. 

10 ‘‘(4) Women should (but are not required to) 

11 consult with appropriate health care practitioners 

12 before undergoing screening mammography or mag13 netic resonance imaging, but nothing in this section 

14 shall be construed as requiring the approval of a 

15 health care practitioner before a woman undergoes 

16 an annual screening mammography or annual mag17 netic resonance imaging. 

18 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 

19 imposition of the requirements of this section shall be 

20 treated as a material modification in the terms of the sum21 mary plan described in section 102(a), for purposes of as22 suring notice of such requirements under the plan; except 

23 that the summary description required to be provided 

24 under the last sentence of section 104(b)(1) with respect 

25 to such modification shall be provided by not later than 


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1 60 days after the first day of the first plan year in which 

2 such requirements apply. 

3 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.— 

4 Nothing in this section shall be construed to prevent a 

5 group health plan or a health insurance issuer offering 

6 group health insurance coverage from negotiating the level 

7 and type of reimbursement with a provider for care pro8 vided in accordance with this section. 

9 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR10 ANCE COVERAGE IN CERTAIN STATES.— 

11 ‘‘(1) SCREENING MAMMOGRAPHY.—The re12 quirements of this section, with respect to annual 

13 screening mammography for women who are 40 

14 years of age or older or for high risk women, shall 

15 not apply with respect to health insurance coverage 

16 if there is a State law (as defined in section 

17 731(d)(1)) for a State that regulates such coverage, 

18 that requires coverage to be provided for annual 

19 screening mammography for women who are 40 

20 years of age or older or for high risk women (as de21 fined in subsection (a)(2)(B)), respectively, and that 

22 provides at least the protections described in sub23 section (b). 

24 ‘‘(2) MAGNETIC RESONANCE IMAGING.—The re25 quirements of this section, with respect to annual 


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1 magnetic resonance imaging, shall not apply with re2 spect to health insurance coverage if there is a State 

3 law (as defined in section 731(d)(1)) for a State 

4 that regulates such coverage, that requires coverage 

5 to be provided for annual magnetic resonance imag6 ing for high risk women (as defined in subsection 

7 (a)(2)(B)), and that provides at least the protections 

8 described in subsection (b). 

9 ‘‘(3) CONSTRUCTION.—Section 731(a)(1) shall 

10 not be construed as superseding a State law de11 scribed in paragraph (1) or (2).’’. 

12 (2) Section 731(c) of such Act (29 U.S.C. 

13 1191(c)) is amended by striking ‘‘section 711’’ and 

14 inserting ‘‘sections 711 and 715’’. 

15 (3) Section 732(a) of such Act (29 U.S.C. 

16 1191a(a)) is amended by striking ‘‘section 711’’ and 

17 inserting ‘‘sections 711 and 715’’. 

18 (4) The table of contents in section 1 of such 

19 Act is amended by inserting after the item relating 

20 to section 714 the following new item: 

‘‘Sec. 715. Standards relating to benefits for screening mammography and 

magnetic resonance imaging.’’. 

21 (c) EFFECTIVE DATES.— 

22 (1) Subject to paragraph (2), the amendments 

23 made by this section shall apply with respect to 

24 group health plans (and health insurance coverage 


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1 offered in connection with group health plans) for 

2 plan years beginning on or after 1 year after the 

3 date of the enactment of this Act. 

4 (2)(A) In the case of a group health plan main5 tained pursuant to 1 or more collective bargaining 

6 agreements between employee representatives and 1 

7 or more employers ratified before the date of the en8 actment of this Act, the amendments made by this 

9 section shall not apply to plan years beginning be10 fore the later of— 

11 (i) the date on which the last collec12 tive bargaining agreements relating to the 

13 plan terminates (determined without re14 gard to any extension thereof agreed to 

15 after the date of the enactment of this 

16 Act); or 

17 (ii) 1 year after the date of the enact18 ment of this Act. 

19 (B) For purposes of subparagraph (A)(i), any 

20 plan amendment made pursuant to a collective bar21 gaining agreement relating to the plan which 

22 amends the plan solely to conform to any require23 ment added by this section shall not be treated as 

24 a termination of such collective bargaining agree25 ment. 


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1 SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOG2 RAPHY AND ANNUAL MAGNETIC RESONANCE 

3 IMAGING UNDER INDIVIDUAL HEALTH COV4 ERAGE. 

5 (a) IN GENERAL.—Part B of title XXVII of the Pub6 lic Health Service Act is amended by inserting after sec7 tion 2753 the following new section: 

8 ‘‘SEC. 2754. STANDARDS RELATING TO BENEFITS FOR 

9 SCREENING MAMMOGRAPHY AND MAGNETIC 

10 RESONANCE IMAGING. 

11 ‘‘(a) IN GENERAL.—The provisions of section 2708 

12 (other than subsections (d) and (f)) shall apply to health 

13 insurance coverage offered by a health insurance issuer 

14 in the individual market in the same manner as it applies 

15 to health insurance coverage offered by a health insurance 

16 issuer in connection with a group health plan in the small 

17 or large group market. 

18 ‘‘(b) NOTICE.—A health insurance issuer under this 

19 part shall comply with the notice requirement under sec20 tion 715(d) of the Employee Retirement Income Security 

21 Act of 1974 with respect to the requirements referred to 

22 in subsection (a) as if such section applied to such issuer 

23 and such issuer were a group health plan. 

24 ‘‘(c) PREEMPTION; EXCEPTION FOR HEALTH INSUR25 ANCE COVERAGE IN CERTAIN STATES.— 


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1 ‘‘(1) ANNUAL SCREENING MAMMOGRAPHY.— 

2 The requirements of this section, with respect to an3 nual screening mammography for women who are 40 

4 years of age or older or for high risk women, shall 

5 not apply with respect to health insurance coverage 

6 if there is a State law (as defined in section 

7 2723(d)(1)) for a State that regulates such cov8 erage, that requires coverage in the individual health 

9 insurance market to be provided for annual screen10 ing mammography for women who are 40 years of 

11 age or older or for high risk women, respectively, 

12 and that provides at least the protections described 

13 in section 2708(b) (as applied under subsection (a)). 

14 ‘‘(2) MAGNETIC RESONANCE IMAGING.—The re15 quirements of this section, with respect to annual 

16 magnetic resonance imaging, shall not apply with re17 spect to health insurance coverage if there is a State 

18 law (as defined in section 2723(d)(1)) for a State 

19 that regulates such coverage, that requires coverage 

20 in the individual health insurance market to be pro21 vided for annual magnetic resonance imaging for 

22 high risk women, and that provides at least the pro23 tections described in section 2708(b) (as applied 

24 under subsection (a)). 


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1 ‘‘(3) CONSTRUCTION.—Section 2762(a) shall 

2 not be construed as superseding a State law de3 scribed in paragraph (1) or (2).’’. 

4 (b) CONFORMING AMENDMENT.—Section 2762(b)(2) 

5 of such Act (42 U.S.C. 300gg–63(b)(2)) is amended by 

6 striking ‘‘section 2751’’ and inserting ‘‘sections 2751 and 

7 2754’’. 

8 (c) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply with respect to health insurance 

10 coverage offered, sold, issued, or renewed in the individual 

11 market on or after the date that is 1 year after the date 

12 of the enactment of this Act. 

Æ 


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