I
106TH CONGRESS
1ST SESSION
H. R. 1285
To amend the Employee Retirement Income Security Act of 1974, Public
Health Service Act, and the Internal Revenue Code of 1986 to require
that group and individual health insurance coverage and group health
plans provide coverage of cancer screening.
IN THE HOUSE OF REPRESENTATIVES
MARCH 25, 1999
Mrs. MALONEY of New York (for herself, Mrs. KELLY, Mr. RANGEL, Mr.
MATSUI, Mr. GILMAN, Mrs. MINK of Hawaii, Mrs. MORELLA, Ms.
SCHAKOWSKY, Mr. FROST, Mr. LANTOS, Mr. GUTIERREZ, Mr. CROWLEY,
Mr. CUMMINGS, and Mr. SANDLIN) introduced the following bill; which
was referred to the Committee on Commerce, and in addition to the Com-
mittees on Education and the Workforce, and Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
A BILL
To amend the Employee Retirement Income Security Act
of 1974, Public Health Service Act, and the Internal
Revenue Code of 1986 to require that group and indi-
vidual health insurance coverage and group health plans
provide coverage of cancer screening.
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 ‘‘Cancer Screening Cov-
erage Act of 1999’’.
SEC. 2. CANCER SCREENING COVERAGE.
(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. 2707. COVERAGE OF CANCER SCREENING.
‘‘(a) REQUIREMENT.—A group health plan, and a
health insurance issuer offering group health insurance
coverage, shall provide coverage and payment under the
plan or coverage for the following items and services under
terms and conditions that are no less favorable than the
terms and conditions applicable to other screening benefits
otherwise provided under the plan or coverage:
‘‘(1) MAMMOGRAMS.—In the case of a female
participant or beneficiary who is 40 years of age or
older, or is under 40 years of age but is at high risk
(as defined in subsection (e)) of developing breast
cancer, an annual mammography (as defined in sec-
tion 1861(jj) of the Social Security Act) conducted
by a facility that has a certificate (or provisional cer-
tificate) issued under section 354 of the Public
Health Service Act.
‘‘(2) CLINICAL BREAST EXAMINATIONS.—In the
case of a female participant or beneficiary who—
‘‘(A)(i) is 40 years of age or older or (ii)
is at least 20 (but less than 40) years of age
and is at high risk of developing breast cancer,
an annual clinical breast examination; or
‘‘(B) is at least 20, but less than 40, years
of age and who is not at high risk of developing
breast cancer, a clinical breast examination
each 3 years.
‘‘(3) PAP TESTS AND PELVIC EXAMINATIONS.—
In the case of a female participant or beneficiary
who is 18 years of age or older, or who is under 18
years of age and is or has been sexually active—
‘‘(A) an annual diagnostic laboratory test
(popularly known as a ‘pap smear’) consisting
of a routine exfoliative cytology test (Papani-
colaou test) provided to a woman for the pur-
pose of early detection of cervical or vaginal
cancer and including an interpretation by a
qualified health professional of the results of
the test; and
‘‘(B) an annual pelvic examination.
‘‘(4) COLORECTAL CANCER SCREENING PROCE-
DURES.—In the case of a participant or beneficiary
who is 50 years of age or older, or who is under 50
years of age and is at high risk of developing
colorectal cancer, all of the following procedures fur-
nished to the individual for the purpose of early de-
tection of colorectal cancer:
‘‘(A) Screening fecal-occult blood test, but
not to exceed once every 12 months.
‘‘(B) Screening flexible sigmoidoscopy, but
not to exceed once every 48 months.
‘‘(C) In the case of an individual at high
risk 
for 
colorectal 
cancer, 
screening
colonoscopy, but not to exceed once every 24
months.
‘‘(D) Such other tests or procedures, and
modifications to tests and procedures under this
paragraph, with such frequency, as the Sec-
retary determines appropriate, in consultation
with appropriate organizations.
Under this paragraph, a screening barium enema
may be substituted either for a screening flexible
sigmoidoscopy or for a screen colonoscopy at the at-
tending physician’s discretion.
‘‘(5) PROSTATE
CANCER
SCREENING.—In the
case of a participant or beneficiary who is 50 years
of age or older, an annual test consisting of any (or
all) 
of 
the 
procedures 
described 
in 
section
1861(oo)(2) of Social Security Act (42 U.S.C.
1395x(oo)(2)) provided for the purpose of early de-
tection of prostate cancer.
‘‘(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 procedure, examination, or test
described in subsection (a).
‘‘(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
714(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) HIGH RISK DEFINED.—For purposes of this
section, an individual is considered to be at ‘high risk’ of
developing a particular type of cancer if, under guidelines
developed or recognized by the Secretary based upon sci-
entific evidence, the individual—
‘‘(1) has one or more close family members who
have developed that type of cancer;
‘‘(2) has previously had that type of cancer;
‘‘(3) has the presence of an appropriate recog-
nized gene marker that is identified as putting the
individual at a higher risk of developing that type of
cancer; or
‘‘(4) has other predisposing factors that signifi-
cantly increases the risk of the individual con-
tracting that type of cancer.
For purposes of this subsection, the term ‘type of cancer’
includes other types of cancer that the Secretary recog-
nizes as closely related for purposes of establishing risk.’’.
(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 2707’’.
(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. 714. COVERAGE OF CANCER SCREENING.
‘‘(a) REQUIREMENT.—A group health plan, and a
health insurance issuer offering group health insurance
coverage, shall provide coverage and payment under the
plan or coverage for the following items and services under
terms and conditions that are no less favorable than the
terms and conditions applicable to other screening benefits
otherwise provided under the plan or coverage:
‘‘(1) MAMMOGRAMS.—In the case of a female
participant or beneficiary who is 40 years of age or
older, or is under 40 years of age but is at high risk
(as defined in subsection (e)) of developing breast
cancer, an annual mammography (as defined in sec-
tion 1861(jj) of the Social Security Act) conducted
by a facility that has a certificate (or provisional cer-
tificate) issued under section 354 of the Public
Health Service Act.
‘‘(2) CLINICAL BREAST EXAMINATIONS.—In the
case of a female participant or beneficiary who—
‘‘(A)(i) is 40 years of age or older or (ii)
is at least 20 (but less than 40) years of age
and is at high risk of developing breast cancer,
an annual clinical breast examination; or
‘‘(B) is at least 20, but less than 40, years
of age and who is not at high risk of developing
breast cancer, a clinical breast examination
each 3 years.
‘‘(3) PAP TESTS AND PELVIC EXAMINATIONS.—
In the case of a female participant or beneficiary
who is 18 years of age or older, or who is under 18
years of age and is or has been sexually active—
‘‘(A) an annual diagnostic laboratory test
(popularly known as a ‘pap smear’) consisting
of a routine exfoliative cytology test (Papani-
colaou test) provided to a woman for the pur-
pose of early detection of cervical or vaginal
cancer and including an interpretation by a
qualified health professional of the results of
the test; and
‘‘(B) an annual pelvic examination.
‘‘(4) COLORECTAL CANCER SCREENING PROCE-
DURES.—In the case of a participant or beneficiary
who is 50 years of age or older, or who is under 50
years of age and is at high risk of developing
colorectal cancer, all of the following procedures fur-
nished to the individual for the purpose of early de-
tection of colorectal cancer:
‘‘(A) Screening fecal-occult blood test, but
not to exceed once every 12 months.
‘‘(B) Screening flexible sigmoidoscopy, but
not to exceed once every 48 months.
‘‘(C) In the case of an individual at high
risk 
for 
colorectal 
cancer, 
screening
colonoscopy, but not to exceed once every 24
months.
‘‘(D) Such other tests or procedures, and
modifications to tests and procedures under this
paragraph, with such frequency, as the Sec-
retary of Health and Human Services deter-
mines appropriate, in consultation with appro-
priate organizations.
Under this paragraph, a screening barium enema
may be substituted either for a screening flexible
sigmoidoscopy or for a screen colonoscopy at the at-
tending physician’s discretion.
‘‘(5) PROSTATE
CANCER
SCREENING.—In the
case of a participant or beneficiary who is 50 years
of age or older, an annual test consisting of any (or
all) 
of 
the 
procedures 
described 
in 
section
1861(oo)(2) of Social Security Act (42 U.S.C.
1395x(oo)(2)) provided for the purpose of early de-
tection of prostate cancer.
‘‘(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 procedure, examination, or test
described in subsection (a).
‘‘(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) HIGH RISK DEFINED.—For purposes of this
section, an individual is considered to be at ‘high risk’ of
developing a particular type of cancer if, under guidelines
developed or recognized by the Secretary based upon sci-
entific evidence, the individual—
‘‘(1) has one or more close family members who
have developed that type of cancer;
‘‘(2) has previously had that type of cancer;
‘‘(3) has the presence of an appropriate recog-
nized gene marker that is identified as putting the
individual at a higher risk of developing that type of
cancer; or
‘‘(4) has other predisposing factors that signifi-
cantly increases the risk of the individual con-
tracting that type of cancer.
For purposes of this subsection, the term ‘type of cancer’
includes other types of cancer that the Secretary recog-
nizes as closely related for purposes of establishing risk.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 713 the following new item:
‘‘Sec. 714. Coverage of cancer screening.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—Subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended—
(A) in the table of sections, by inserting
after the item relating to section 9812 the fol-
lowing new item:
‘‘Sec. 9813. Coverage of cancer screening.’’; and
(B) by inserting after section 9812 the fol-
lowing:
‘‘SEC. 9813. COVERAGE OF CANCER SCREENING.
‘‘(a) REQUIREMENT.—A group health plan shall pro-
vide coverage and payment under the plan for the fol-
lowing items and services under terms and conditions that
are no less favorable than the terms and conditions appli-
cable to other screening benefits otherwise provided under
the plan:
‘‘(1) MAMMOGRAMS.—In the case of a female
participant or beneficiary who is 40 years of age or
older, or is under 40 years of age but is at high risk
(as defined in subsection (d)) of developing breast
cancer, an annual mammography (as defined in sec-
tion 1861(jj) of the Social Security Act) conducted
by a facility that has a certificate (or provisional cer-
tificate) issued under section 354 of the Public
Health Service Act.
‘‘(2) CLINICAL BREAST EXAMINATIONS.—In the
case of a female participant or beneficiary who—
‘‘(A)(i) is 40 years of age or older or (ii)
is at least 20 (but less than 40) years of age
and is at high risk of developing breast cancer,
an annual clinical breast examination; or
‘‘(B) is at least 20, but less than 40, years
of age and who is not at high risk of developing
breast cancer, a clinical breast examination
each 3 years.
‘‘(3) PAP TESTS AND PELVIC EXAMINATIONS.—
In the case of a female participant or beneficiary
who is 18 years of age or older, or who is under
18 years of age and is or has been sexually active—
‘‘(A) an annual diagnostic laboratory test
(popularly known as a ‘pap smear’) consisting
of a routine exfoliative cytology test (Papani-
colaou test) provided to a woman for the pur-
pose of early detection of cervical or vaginal
cancer and including an interpretation by a
qualified health professional of the results of
the test; and
‘‘(B) an annual pelvic examination.
‘‘(4) COLORECTAL CANCER SCREENING PROCE-
DURES.—In the case of a participant or beneficiary
who is 50 years of age or older, or who is under 50
years of age and is at high risk of developing
colorectal cancer, all of the following procedures fur-
nished to the individual for the purpose of early de-
tection of colorectal cancer:
‘‘(A) Screening fecal-occult blood test, but
not to exceed once every 12 months.
‘‘(B) Screening flexible sigmoidoscopy, but
not to exceed once every 48 months.
‘‘(C) In the case of an individual at high
risk 
for 
colorectal 
cancer, 
screening
colonoscopy, but not to exceed once every 24
months.
‘‘(D) Such other tests or procedures, and
modifications to tests and procedures under this
paragraph, with such frequency, as the Sec-
retary of Health and Human Services deter-
mines appropriate, in consultation with appro-
priate organizations.
Under this paragraph, a screening barium enema
may be substituted either for a screening flexible
sigmoidoscopy or for a screen colonoscopy at the at-
tending physician’s discretion.
‘‘(5) PROSTATE
CANCER
SCREENING.—In the
case of a participant or beneficiary who is 50 years
of age or older, an annual test consisting of any (or
all) 
of 
the 
procedures 
described 
in 
section
1861(oo)(2) of Social Security Act (42 U.S.C.
1395x(oo)(2)) provided for the purpose of early de-
tection of prostate cancer.
‘‘(b) PROHIBITIONS.—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 procedure, examination, or test
described in subsection (a).
‘‘(2) Nothing in this section shall be construed
as preventing a group health plan from imposing
deductibles, coinsurance, or other cost-sharing in re-
lation to benefits described in subsection (a) con-
sistent with such subsection, except that such coin-
surance or other cost-sharing shall not discriminate
on any basis related to the coverage required under
this section.
‘‘(d) HIGH RISK DEFINED.—For purposes of this
section, an individual is considered to be at ‘high risk’ of
developing a particular type of cancer if, under guidelines
developed or recognized by the Secretary based upon sci-
entific evidence, the individual—
‘‘(1) has one or more close family members who
have developed that type of cancer;
‘‘(2) has previously had that type of cancer;
‘‘(3) has the presence of an appropriate recog-
nized gene marker that is identified as putting the
individual at a higher risk of developing that type of
cancer; or
‘‘(4) has other predisposing factors that signifi-
cantly increases the risk of the individual con-
tracting that type of cancer.
For purposes of this subsection, the term ‘type of cancer’
includes other types of cancer that the Secretary recog-
nizes as closely related for purposes of establishing risk.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2752 the following new sec-
tion:
‘‘SEC. 2753. STANDARD RELATING PATIENT FREEDOM OF
CHOICE.
‘‘(a) IN GENERAL.—The provisions of section 2707
(other than subsection (d)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market with respect to an enrollee under such cov-
erage in the same manner as they apply to health insur-
ance coverage offered by a health insurance issuer in con-
nection with a group health plan in the small or large
group market to a participant or beneficiary in such plan.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 714(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.’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)) is amended by striking ‘‘section 2751’’
and inserting ‘‘sections 2751 and 2753’’.
(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, 2000.
(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 indi-
vidual 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 to 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, 2000.
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’’.
Æ