I
104TH CONGRESS
2D SESSION
H. R. 3630
To require coverage of screening mammography and pap smears under health
plans.
IN THE HOUSE OF REPRESENTATIVES
JUNE 12, 1996
Mr. FOX of Pennsylvania (for himself, Mr. GENE GREEN of Texas, Mr. LIPIN-
SKI, Mrs. ROUKEMA, Mr. DAVIS, and Mr. FORBES) introduced the follow-
ing bill; which was referred to the Committee on Commerce, and in addi-
tion to the Committee on Economic and Educational Opportunities, 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 com-
mittee concerned
A BILL
To require coverage of screening mammography and pap
smears under health plans.
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 ‘‘Women’s Preventive
Health Care Act of 1996’’.
SEC. 2. REQUIRING COVERAGE OF SCREENING MAMMOG-
RAPHY AND PAP SMEARS UNDER HEALTH
PLANS.
(a) IN GENERAL.—Every policy or contract that pro-
vides health insurance coverage (as defined in subsection
(h)(1)) and every group health plan (as defined in sub-
section (h)(2)) shall include (consistent with this sec-
tion)—
(1) coverage for screening pap smears, and
(2) coverage for low-dose screening mammog-
raphy.
(b) DEFINITIONS RELATING TO COVERAGE.—In this
section:
(1) LOW-DOSE
SCREENING
MAMMOGRAPHY.—
The term ‘‘low-dose screening mammography’’
means a radiologic procedure for the early detection
of breast cancer provided to an asymptomatic
women using equipment dedicated specifically for
mammography and at a facility which meets mam-
mography accreditation standards established by the
Secretary for coverage of screening mammography
under the medicare program under title XVIII of the
Social Security Act. Such term also includes a physi-
cian’s interpretation of the results of the procedure.
(2) 
SCREENING
PAP
SMEAR.—The 
term
‘‘screening pap smear’’ means a diagnostic labora-
tory test consisting of a routine exfoliative cytology
test (Papanicolaou test) provided to a woman for the
purpose of early detection of cervical cancer and in-
cludes the examination, the laboratory test itself,
and a physician’s interpretation of the results of the
test. If the Secretary establishes qualify standards
for facilities furnishing screening pap smears, such
term shall only include a test if the test is performed
in a facility that has been determined to meet such
standards.
(c) RESTRICTIONS
ON COST-SHARING.—The cov-
erage under this section shall not provide for the applica-
tion of deductibles, coinsurance, or other limitations for
low-dose screening mammography or screening pap
smears that are greater than the deductibles, coinsurance,
and limitations that are applied to similar services under
the health insurance coverage or group health plan.
(d) FREQUENCY OF COVERAGE OF SCREENING MAM-
MOGRAPHY.—
(1) IN GENERAL.—Coverage of low-dose screen-
ing mammography is consistent with this section
only if it is provided consistent with the following
periodicity schedule:
(A) Coverage is made available for one
baseline low-dose screening mammography for
any woman between 35 and 40 years of age.
(B) Coverage is made available for such
mammography on an annual basis to any
woman who is 50 years or age or older or who
is determined by a physician to be at-risk of
breast cancer (as defined in paragraph (2)).
(C) Coverage is made available for such
mammography for a woman at least once every
other year.
(2) AT-RISK
OF
BREAST
CANCER.—For pur-
poses of paragraph (1)(B), a woman is considered to
be ‘‘at-risk of breast cancer’’ if any of the following
is true:
(A) The woman has a personal history of
breast cancer.
(B) The woman has a personal history of
biopsy-proven benign breast disease.
(C) The woman’s mother, sister, or daugh-
ter has or has had breast cancer.
(D) The woman has not given birth prior
to the age of 30.
(e) FREQUENCY OF COVERAGE OF SCREENING PAP
SMEARS.—Coverage of screening pap smears is consistent
with this section only if it is provided not more often than
once every year (or more frequently if recommended by
a physician).
(f) ENFORCEMENT.—
(1) REGULATED INSURERS.—It is the respon-
sibility of State regulators what regulate insurers
that offer health insurance coverage in a State to
apply the requirements of this section to such insur-
ers and coverage. If the Secretary determines that
such regulators do not have the intent or means of
enforcing such requirements with respect to such in-
surers in a State, the Secretary may provide such
remedies (which may include civil money penalties)
as may be necessary to assure compliance with the
requirements of this section in such State.
(2) GROUP HEALTH PLANS.—The requirements
of this section are deemed, in relation to group
health plans offered as employee welfare benefit
plans under title I of Employee Retirement Income
Security Act of 1974, to be provisions of such title,
for purposes of applying the enforcement related
provisions of such title.
(3) OTHER PLANS.—In the case of health cov-
erage not described in paragraph (1) or (2), the Sec-
retary shall develop such non-criminal enforcement
mechanisms as may be necessary and appropriate to
carry out this section in relation to entities offering
such coverage.
(g) RELATION TO STATE LAW.—The provisions of
this section do not preempt State law to the extent such
State law provides greater protection to women in relation
to the benefits provided under this section.
(h) DEFINITIONS.—In this section:
(1) HEALTH INSURANCE COVERAGE.—
(A) IN GENERAL.—Except as provided in
subparagraph (B), the term ‘‘health insurance
coverage’’ means benefits consisting of medical
care (provided directly, through insurance or re-
imbursement, or otherwise) under any hospital
or medical service policy or certificate, hospital
or medical service plan contract, or health
maintenance organization group contract of-
fered by an insurer or a health maintenance or-
ganization.
(B) EXCEPTION.—Such term does not in-
clude coverage under any separate policy, cer-
tificate, or contract only for one or more of any
of the following:
(i) Coverage for accident, credit-only,
vision, disability income, long-term care,
nursing home care, community-based care
dental, on-site medical clinics, or employee
assistance programs, or any combination
thereof.
(ii) Medicare supplemental health in-
surance (within the meaning of section
1882(g)(1) of the Social Security Act (42
U.S.C. 1395ss(g)(1))) and similar supple-
mental coverage provided under a group
health plan.
(iii) Coverage issued as a supplement
to liability insurance.
(iv) Liability insurance, including gen-
eral liability insurance and automobile li-
ability insurance.
(v) Workers’ compensation or similar
insurance.
(vi) Automobile medical-payment in-
surance.
(vii) Coverage for a specified disease
or illness.
(viii) Hospital or fixed indemnity in-
surance.
(ix) Short-term limited duration in-
surance.