I
105TH CONGRESS
2D SESSION
H. R. 4333
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to require
that group and individual health insurance coverage and group health
plans provide coverage of annual mammograms and annual prostate
cancer screening tests following the model established under the Medicare
Program.
IN THE HOUSE OF REPRESENTATIVES
JULY 24, 1998
Mrs. MALONEY of New York introduced the following bill; which was referred
to the Committee on Commerce, and in addition to the Committees on
Education and the Workforce, and Ways and Means, 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 con-
cerned
A BILL
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, and the Internal
Revenue Code of 1986 to require that group and individ-
ual health insurance coverage and group health plans
provide coverage of annual mammograms and annual
prostate cancer screening tests following the model estab-
lished under the Medicare Program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Annual Mammogram
and Prostate Cancer Screening Coverage Act of 1998’’.
SEC. 2. COVERAGE OF ANNUAL MAMMOGRAMS AND AN-
NUAL PROSTATE CANCER SCREENING TESTS
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act is amended by adding
at the end the following new section:
‘‘SEC. 2706. STANDARDS RELATING TO BENEFITS FOR AN-
NUAL MAMMOGRAMS AND ANNUAL PROS-
TATE CANCER SCREENING TESTS.
‘‘(a) REQUIREMENT.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, shall provide coverage for—
‘‘(A) annual screening mammograms for
female participants and beneficiaries who are
40 years of age or older; and
‘‘(B) annual prostate cancer screening
testing for male participants and beneficiaries
who are 50 years of age or older.
‘‘(2) REGULATIONS.—The Secretary shall pro-
mulgate regulations to carry out this section. In pro-
mulgating such regulations, the Secretary shall pro-
vide that the coverage required under paragraph (1)
shall be comparable to the coverage of similar bene-
fits under the medicare program under part B of
title XVIII of the Social Security Act.
‘‘(b) PROHIBITIONS.—A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, may
not—
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under
the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
‘‘(2) provide monetary payments or rebates to
individuals to encourage such individuals to accept
less than the minimum protections available under
this section;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider
provided care to an individual participant or bene-
ficiary in accordance with this section; or
‘‘(4) provide incentives (monetary or otherwise)
to a provider to induce such provider to provide care
to an individual participant or beneficiary in a man-
ner inconsistent with this section.
‘‘(c) RULES OF CONSTRUCTION.—
‘‘(1) Nothing in this section shall be construed
to require an individual who is a participant or bene-
ficiary to undergo a screening mammogram or pros-
tate cancer screening test.
‘‘(2) Nothing in this section shall be construed
as preventing a group health plan or issuer from im-
posing deductibles, coinsurance, or other cost-shar-
ing in relation to benefits described in subsection (a)
consistent with such subsection, except that such co-
insurance or other cost-sharing shall not discrimi-
nate on any basis related to the coverage required
under this section.
‘‘(d) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
713(d) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage from negotiating the level
and type of reimbursement with a provider for care pro-
vided in accordance with this section.’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)) is amended by striking ‘‘section 2704’’
and inserting ‘‘sections 2704 and 2706’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 713. STANDARDS RELATING TO BENEFITS FOR AN-
NUAL MAMMOGRAMS AND ANNUAL PROS-
TATE CANCER SCREENING TESTS.
‘‘(a) REQUIREMENT.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, shall provide coverage for—
‘‘(A) annual screening mammograms for
participants and beneficiaries who are 40 years
of age or older; and
‘‘(B) annual prostate cancer screening
testing for male participants and beneficiaries
who are 50 years of age or older.
‘‘(2) REGULATIONS.—The Secretary shall pro-
mulgate regulations to carry out this section. In pro-
mulgating such regulations, the Secretary shall pro-
vide that the coverage required under paragraph (1)
shall be comparable to the coverage of similar bene-
fits under the medicare program under part B of
title XVIII of the Social Security Act.
‘‘(b) PROHIBITIONS.—A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, may
not—
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under
the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
‘‘(2) provide monetary payments or rebates to
individuals to encourage such individuals to accept
less than the minimum protections available under
this section;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider
provided care to an individual participant or bene-
ficiary in accordance with this section; or
‘‘(4) provide incentives (monetary or otherwise)
to a provider to induce such provider to provide care
to an individual participant or beneficiary in a man-
ner inconsistent with this section.
‘‘(c) RULES OF CONSTRUCTION.—
‘‘(1) Nothing in this section shall be construed
to require an individual who is a participant or bene-
ficiary to undergo a screening mammogram or pros-
tate cancer screening test.
‘‘(2) Nothing in this section shall be construed
as preventing a group health plan or issuer from im-
posing deductibles, coinsurance, or other cost-shar-
ing in relation to benefits described in subsection (a)
consistent with such subsection, except that such co-
insurance or other cost-sharing shall not discrimi-
nate on any basis related to the coverage required
under this section.
‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirement of this section shall be treat-
ed as a material modification in the terms of the plan de-
scribed in section 102(a)(1), for purposes of assuring no-
tice of such requirements under the plan; except that the
summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirement apply.
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage from negotiating the level
and type of reimbursement with a provider for care pro-
vided in accordance with this section.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 713’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 713’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Standards relating to benefits for annual mammograms and annual
prostate cancer screening tests.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—Subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 (as amended by section
1531(a) of the Taxpayer Relief Act of 1997) is
amended—
(A) in the table of sections, by inserting after
the item relating to section 9812 the following new
item:
‘‘Sec. 9813. Standards relating to benefits for annual mammo-
grams and annual prostate cancer screening tests.’’;
and
(B) by inserting after section 9812 the follow-
ing:
‘‘SEC. 9813. STANDARDS RELATING TO BENEFITS FOR AN-
NUAL MAMMOGRAMS AND ANNUAL PROS-
TATE CANCER SCREENING TESTS.
‘‘A group health plan shall comply with the require-
ments of section 713(a) of the Employee Retirement In-
come Security Act of 1974.’’
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2751 the following new sec-
tion:
‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR AN-
NUAL MAMMOGRAMS AND ANNUAL PROS-
TATE CANCER SCREENING TESTS.
‘‘(a) IN GENERAL.—The provisions of section 2706
(other than subsection (d)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health
insurance coverage offered by a health insurance issuer
in connection with a group health plan in the small or
large group market.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 713(d) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.’’.
(c) EFFECTIVE DATES.—(1) Subject to paragraph
(3), the amendments made by subsection (a) shall apply
with respect to group health plans for plan years begin-
ning on or after January 1, 1999.
(2) The amendment made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the individ-
ual market on or after such date.
(3) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made subsection (a) shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(B) January 1, 1999.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by subsection (a) shall not be
treated as a termination of such collective bargaining
agreement.
(d) COORDINATED REGULATIONS.—Section 104(1)
of Health Insurance Portability and Accountability Act of
1996 is amended by striking ‘‘this subtitle (and the
amendments made by this subtitle and section 401)’’ and
inserting ‘‘the provisions of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of
1974, the provisions of parts A and C of title XXVII of
the Public Health Service Act, and chapter 100 of the In-
ternal Revenue Code of 1986’’.
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