I 
111TH CONGRESS 
2D SESSION 
H. R. 4563 
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 screening for breast, prostate, and colorectal 
cancer. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 2, 2010 
Mrs. MALONEY introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Education and Labor, Ways and Means, and Oversight and Government 
Reform, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee 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 screening for breast, prostate, and 
colorectal cancer. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Cancer Screening Cov-
erage Act of 2009’’. 
SEC. 2. CANCER SCREENING COVERAGE. 
(a) GROUP HEALTH PLANS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.— 
(A) IN GENERAL.—Subpart 2 of part A of 
title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–4 et seq.) is amended by 
adding at the end the following: 
‘‘SEC. 2708. 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 
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by a facility that has a certificate (or provisional cer-
tificate) issued under section 354. 
‘‘(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 
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‘‘(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, the procedures described in section 
1861(pp)(1) of the Social Security Act (42 U.S.C. 
1395x(pp)(1)) or section 4104(a)(2) of the Balanced 
Budget Act of 1997 (111 Stat. 362), shall be fur-
nished to the individual for the purpose of early de-
tection of colorectal cancer. The group health plan 
or health insurance issuer shall provide coverage for 
the method and frequency of colorectal cancer 
screening determined to be appropriate by a health 
care provider treating such participant or bene-
ficiary, in consultation with the participant or bene-
ficiary. 
‘‘(5) PROSTATE CANCER SCREENING.—In the 
case of a male participant or beneficiary who is 50 
years of age or older, or who is younger than 50 
years of age and is at high risk for prostate cancer 
(including African-American men or a male who has 
a history of prostate cancer in 1 or more first degree 
family members), the procedures described in section 
1861(oo)(2) of Social Security Act (42 U.S.C. 
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1395x(oo)(2)) shall be furnished to the individual 
for the early detection of prostate cancer. The group 
health plan or health insurance issuer shall provide 
coverage for the method and frequency of prostate 
cancer screening determined to be appropriate by a 
health care provider treating such participant or 
beneficiary, in consultation with the participant or 
beneficiary. 
‘‘(b) PROHIBITIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan, shall 
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 
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‘‘(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 
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developed or recognized by the Secretary based upon sci-
entific evidence, the individual— 
‘‘(1) has 1 or more first degree 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 increase the risk of the individual contracting 
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. 
‘‘SEC. 2709. PATIENT ACCESS TO INFORMATION. 
‘‘(a) DISCLOSURE REQUIREMENT.—A group health 
plan, and health insurance issuer offering group health in-
surance coverage shall— 
‘‘(1) provide to participants and beneficiaries at 
the time of initial coverage under the plan (or the 
effective date of this section, in the case of individ-
uals who are participants or beneficiaries as of such 
date), and at least annually thereafter, the informa-
tion described in subsection (b) in printed form; 
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‘‘(2) provide to participants and beneficiaries, 
within a reasonable period (as specified by the ap-
propriate Secretary) before or after the date of sig-
nificant changes in the information described in sub-
section (b), information in printed form regarding 
such significant changes; and 
‘‘(3) upon request, make available to partici-
pants and beneficiaries, the applicable authority, and 
prospective participants and beneficiaries, the infor-
mation described in subsection (b) in printed form. 
‘‘(b) INFORMATION PROVIDED.—The information de-
scribed in subsection (a) that shall be disclosed includes 
the following, as such relates to cancer screening required 
under section 2708(a): 
‘‘(1) BENEFITS.—Benefits offered under the 
plan or coverage, including— 
‘‘(A) covered benefits, including benefit 
limits and coverage exclusions; 
‘‘(B) cost sharing, such as deductibles, co-
insurance, and copayment amounts, including 
any liability for balance billing, any maximum 
limitations on out of pocket expenses, and the 
maximum out of pocket costs for services that 
are provided by nonparticipating providers or 
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that are furnished without meeting the applica-
ble utilization review requirements; 
‘‘(C) the extent to which benefits may be 
obtained from nonparticipating providers; and 
‘‘(D) the extent to which a participant, 
beneficiary, or enrollee may select from among 
participating providers and the types of pro-
viders participating in the plan or issuer net-
work. 
‘‘(2) ACCESS.—A description of the following: 
‘‘(A) The number, mix, and distribution of 
providers under the plan or coverage. 
‘‘(B) Out-of-network coverage (if any) pro-
vided by the plan or coverage. 
‘‘(C) Any point-of-service option (including 
any supplemental premium or cost-sharing for 
such option). 
‘‘(D) The procedures for participants, 
beneficiaries, and enrollees to select, access, and 
change participating primary and specialty pro-
viders. 
‘‘(E) The rights and procedures for obtain-
ing referrals (including standing referrals) to 
participating and nonparticipating providers. 
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‘‘(F) The name, address, and telephone 
number of participating health care providers 
and an indication of whether each such provider 
is available to accept new patients. 
‘‘(G) How the plan or issuer addresses the 
needs of participants, beneficiaries, and enroll-
ees and others who do not speak English or 
who have other special communications needs in 
accessing providers under the plan or coverage, 
including the provision of information under 
this subsection.’’. 
(B) 
TECHNICAL
AMENDMENT.—Section 
2723(c) of the Public Health Service Act (42 
U.S.C. 300gg–23(c)) is amended by striking 
‘‘section 2704’’ and inserting ‘‘sections 2704 
and 2708’’. 
(2) ERISA AMENDMENTS.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185 
et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 715. COVERAGE OF CANCER SCREENING. 
‘‘(a) REQUIREMENT.—A group health plan, and a 
health insurance issuer offering group health insurance 
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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. 
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‘‘(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, the procedures described in section 
1861(pp)(1) of the Social Security Act (42 U.S.C. 
1395x(pp)(1)) or section 4104(a)(2) of the Balanced 
Budget Act of 1997 (111 Stat. 362), shall be fur-
nished to the individual for the purpose of early de-
tection of colorectal cancer. The group health plan 
or health insurance issuer shall provided coverage 
for the method and frequency of colorectal cancer 
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screening determined to be appropriate by a health 
care provider treating such participant or bene-
ficiary, in consultation with the participant or bene-
ficiary. 
‘‘(5) PROSTATE CANCER SCREENING.—In the 
case of a male participant or beneficiary who is 50 
years of age or older, or who is younger than 50 
years of age and is at high risk for prostate cancer 
(including African-American men or a male who has 
a history of prostate cancer in 1 or more first degree 
family members), the procedures described in section 
1861(oo)(2) of Social Security Act (42 U.S.C. 
1395x(oo)(2)) shall be furnished to the individual 
for the early detection of prostate cancer. The group 
health plan or health insurance issuer shall provide 
coverage for the method and frequency of prostate 
cancer screening determined to be appropriate by a 
health care provider treating such participant or 
beneficiary, in consultation with the participant or 
beneficiary. 
‘‘(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— 
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‘‘(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) 
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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), for purposes of assuring notice 
of such requirements under the plan; except that the sum-
mary description required to be provided under the last 
sentence of section 104(b)(1) with respect to such modi-
fication shall be provided by not later than 60 days after 
the first day of the first plan year in which such require-
ment 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 1 or more first degree 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 
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individual at a higher risk of developing that type of 
cancer; or 
‘‘(4) has other predisposing factors that signifi-
cantly increase the risk of the individual contracting 
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. 
‘‘SEC. 716. PATIENT ACCESS TO INFORMATION. 
‘‘(a) DISCLOSURE REQUIREMENT.—A group health 
plan, and health insurance issuer offering group health in-
surance coverage shall— 
‘‘(1) provide to participants and beneficiaries at 
the time of initial coverage under the plan (or the 
effective date of this section, in the case of individ-
uals who are participants or beneficiaries as of such 
date), and at least annually thereafter, the informa-
tion described in subsection (b) in printed form; 
‘‘(2) provide to participants and beneficiaries, 
within a reasonable period (as specified by the ap-
propriate Secretary) before or after the date of sig-
nificant changes in the information described in sub-
section (b), information in printed form regarding 
such significant changes; and 
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‘‘(3) upon request, make available to partici-
pants and beneficiaries, the applicable authority, and 
prospective participants and beneficiaries, the infor-
mation described in subsection (b) in printed form. 
‘‘(b) INFORMATION PROVIDED.—The information de-
scribed in subsection (a) that shall be disclosed includes 
the following, as such relates to cancer screening required 
under section 715(a): 
‘‘(1) BENEFITS.—Benefits offered under the 
plan or coverage, including— 
‘‘(A) covered benefits, including benefit 
limits and coverage exclusions; 
‘‘(B) cost sharing, such as deductibles, co-
insurance, and copayment amounts, including 
any liability for balance billing, any maximum 
limitations on out of pocket expenses, and the 
maximum out of pocket costs for services that 
are provided by nonparticipating providers or 
that are furnished without meeting the applica-
ble utilization review requirements; 
‘‘(C) the extent to which benefits may be 
obtained from nonparticipating providers; and 
‘‘(D) the extent to which a participant, 
beneficiary, or enrollee may select from among 
participating providers and the types of pro-
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viders participating in the plan or issuer net-
work. 
‘‘(2) ACCESS.—A description of the following: 
‘‘(A) The number, mix, and distribution of 
providers under the plan or coverage. 
‘‘(B) Out-of-network coverage (if any) pro-
vided by the plan or coverage. 
‘‘(C) Any point-of-service option (including 
any supplemental premium or cost-sharing for 
such option). 
‘‘(D) The procedures for participants, 
beneficiaries, and enrollees to select, access, and 
change participating primary and specialty pro-
viders. 
‘‘(E) The rights and procedures for obtain-
ing referrals (including standing referrals) to 
participating and nonparticipating providers. 
‘‘(F) The name, address, and telephone 
number of participating health care providers 
and an indication of whether each such provider 
is available to accept new patients. 
‘‘(G) How the plan or issuer addresses the 
needs of participants, beneficiaries, and enroll-
ees and others who do not speak English or 
who have other special communications needs in 
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accessing providers under the plan or coverage, 
including the provision of information under 
this subsection.’’. 
(B) TECHNICAL AMENDMENTS.— 
(i) Section 731(c) of the Employee 
Retirement Income Security Act of 1974 
(29 U.S.C. 1191(c)) is amended by strik-
ing ‘‘section 711’’ and inserting ‘‘sections 
711 and 715’’. 
(ii) Section 732(a) of the Employee 
Retirement Income Security Act of 1974 
(29 U.S.C. 1191a(a)) is amended by strik-
ing ‘‘section 711’’ and inserting ‘‘sections 
711 and 715’’. 
(iii) The table of contents in section 1 
of the Employee Retirement Income Secu-
rity Act of 1974 is amended by inserting 
after the item relating to section 714 the 
following new items: 
‘‘Sec. 715. Coverage of cancer screening. 
‘‘Sec. 716. Patient access to information.’’. 
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
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is amended by inserting after section 9813 the 
following: 
‘‘SEC. 9814. 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 
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‘‘(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, the procedures described in section 
1861(pp)(1) of the Social Security Act (42 U.S.C. 
1395x(pp)(1)) or section 4104(a)(2) of the Balanced 
Budget Act of 1997 (111 Stat. 362), shall be fur-
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nished to the individual for the purpose of early de-
tection of colorectal cancer. The group health plan 
or health insurance issuer shall provide coverage for 
the method and frequency of colorectal cancer 
screening determined to be appropriate by a health 
care provider treating such participant or bene-
ficiary, in consultation with the participant or bene-
ficiary. 
‘‘(5) PROSTATE CANCER SCREENING.—In the 
case of a male participant or beneficiary who is 50 
years of age or older, or who is younger than 50 
years of age and is at high risk for prostate cancer 
(including African-American men or a male who has 
a history of prostate cancer in 1 or more first degree 
family members), the procedures described in section 
1861(oo)(2) of Social Security Act (42 U.S.C. 
1395x(oo)(2)) shall be furnished to the individual 
for the early detection of prostate cancer. The group 
health plan or health insurance issuer shall provide 
coverage for the method and frequency of prostate 
cancer screening determined to be appropriate by a 
health care provider treating such participant or 
beneficiary, in consultation with the participant or 
beneficiary. 
‘‘(b) PROHIBITIONS.—A group health plan may not— 
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‘‘(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-
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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 1 or more first degree 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 increase the risk of the individual contracting 
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. 
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‘‘SEC. 9815. PATIENT ACCESS TO INFORMATION. 
‘‘(a) DISCLOSURE REQUIREMENT.—A group health 
plan, and health insurance issuer offering group health in-
surance coverage shall— 
‘‘(1) provide to participants and beneficiaries at 
the time of initial coverage under the plan (or the 
effective date of this section, in the case of individ-
uals who are participants or beneficiaries as of such 
date), and at least annually thereafter, the informa-
tion described in subsection (b) in printed form; 
‘‘(2) provide to participants and beneficiaries, 
within a reasonable period (as specified by the ap-
propriate Secretary) before or after the date of sig-
nificant changes in the information described in sub-
section (b), information in printed form regarding 
such significant changes; and 
‘‘(3) upon request, make available to partici-
pants and beneficiaries, the applicable authority, and 
prospective participants and beneficiaries, the infor-
mation described in subsection (b) in printed form. 
‘‘(b) INFORMATION PROVIDED.—The information de-
scribed in subsection (a) that shall be disclosed includes 
the following, as such relates to cancer screening required 
under section 9814(a): 
‘‘(1) BENEFITS.—Benefits offered under the 
plan or coverage, including— 
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‘‘(A) covered benefits, including benefit 
limits and coverage exclusions; 
‘‘(B) cost sharing, such as deductibles, co-
insurance, and copayment amounts, including 
any liability for balance billing, any maximum 
limitations on out of pocket expenses, and the 
maximum out of pocket costs for services that 
are provided by nonparticipating providers or 
that are furnished without meeting the applica-
ble utilization review requirements; 
‘‘(C) the extent to which benefits may be 
obtained from nonparticipating providers; and 
‘‘(D) the extent to which a participant, 
beneficiary, or enrollee may select from among 
participating providers and the types of pro-
viders participating in the plan or issuer net-
work. 
‘‘(2) ACCESS.—A description of the following: 
‘‘(A) The number, mix, and distribution of 
providers under the plan or coverage. 
‘‘(B) Out-of-network coverage (if any) pro-
vided by the plan or coverage. 
‘‘(C) Any point-of-service option (including 
any supplemental premium or cost-sharing for 
such option). 
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‘‘(D) The procedures for participants, 
beneficiaries, and enrollees to select, access, and 
change participating primary and specialty pro-
viders. 
‘‘(E) The rights and procedures for obtain-
ing referrals (including standing referrals) to 
participating and nonparticipating providers. 
‘‘(F) The name, address, and telephone 
number of participating health care providers 
and an indication of whether each such provider 
is available to accept new patients. 
‘‘(G) How the plan or issuer addresses the 
needs of participants, beneficiaries, and enroll-
ees and others who do not speak English or 
who have other special communications needs in 
accessing providers under the plan or coverage, 
including the provision of information under 
this subsection.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections of chapter is amended by inserting 
after the item relating to section 9812 the fol-
lowing new items: 
‘‘Sec. 9814. Coverage of cancer screening. 
‘‘Sec. 9815. Patient access to information.’’. 
(b) INDIVIDUAL HEALTH INSURANCE.— 
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(1) IN GENERAL.—Part B of title XXVII of the 
Public Health Service Act is amended by inserting 
after section 2752 (42 U.S.C. 300gg–52) the fol-
lowing new section: 
‘‘SEC. 2754. STANDARD RELATING PATIENT FREEDOM OF 
CHOICE. 
‘‘(a) IN GENERAL.—The provisions of section 2708 
(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. 
‘‘SEC. 2755. PATIENT ACCESS TO INFORMATION. 
‘‘The provisions of section 2709 shall apply health in-
surance coverage offered by a health insurance issuer in 
the individual market with respect to an enrollee under 
such coverage in the same manner as they apply to health 
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insurance coverage offered by a health insurance issuer 
in connection with a group health plan in the small or 
large group market to a participant or beneficiary in such 
plan.’’. 
(2) 
TECHNICAL
AMENDMENT.—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 2754’’. 
(c) EFFECTIVE DATES.— 
(1) GROUP HEALTH PLANS.—Subject to para-
graph (3), the amendments made by subsection (a) 
shall apply with respect to group health plans for 
plan years beginning on or after January 1, 2010. 
(2) INDIVIDUAL PLANS.—The amendment made 
by subsection (b) shall apply with respect to health 
insurance coverage offered, sold, issued, renewed, in 
effect, or operated in the individual market on or 
after such date. 
(3) COLLECTIVE BARGAINING AGREEMENT.—In 
the case of a group health plan maintained pursuant 
to 1 or more collective bargaining agreements be-
tween employee representatives and 1 or more em-
ployers ratified before the date of enactment of this 
Act, the amendments made to subsection (a) shall 
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not apply to plan years beginning before the later 
of— 
(A) the date on which the last collective 
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or 
(B) January 1, 2010. 
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining 
agreement relating 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 (Public Law 104–191) 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 Internal Revenue Code of 1986’’. 
(e) MODIFICATION OF COVERAGE.— 
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(1) IN GENERAL.—The Secretary of Health and 
Human Services may modify the coverage require-
ments for the amendments under this Act to allow 
such requirements to incorporate and reflect new sci-
entific and technological advances regarding cancer 
screening, practice pattern changes in such screen-
ing, or other updated medical practices regarding 
such screening, such as the use of new tests or other 
emerging technologies. Such modifications shall not 
in any way diminish the coverage requirements listed 
under this Act. Such modifications may be made on 
the Secretary’s own initiative or upon petition to the 
Secretary by an individual or organization. 
(2) CONSULTATION.—In modifying coverage re-
quirements under paragraph (1), the Secretary of 
Health and Human Services shall consult with ap-
propriate organizations, experts, and agencies. 
(3) PETITIONS.—The Secretary of Health and 
Human Services may issue requirements for the pe-
titioning process under paragraph (1), including re-
quirements that the petition be in writing and in-
clude scientific or medical bases for the modification 
sought. Upon receipt of such a petition, the Sec-
retary shall respond to the petitioner and decide 
whether to propose a regulation proposing a change 
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within 90 days of such receipt. If a regulation is re-
quired, the Secretary shall propose such regulation 
within 6 months of such determination. The Sec-
retary shall provide the petitioner the reasons for 
the decision of the Secretary. The Secretary may 
make changes requested by a petitioner in whole or 
in part. 
SEC. 3. APPLICATION TO OTHER HEALTH CARE COVERAGE. 
Chapter 89 of title 5, United States Code, is amended 
by adding at the end the following: 
‘‘§ 8915. Standards relating to coverage of cancer 
screening and patient access to informa-
tion 
‘‘(a) The provisions of sections 2708 and 2709 of the 
Public Health Service Act shall apply to the provision of 
items and services under this chapter. 
‘‘(b) Nothing in this section or section 2708(c) of the 
Public Health Service Act shall be construed as author-
izing a health insurance issuer or entity to impose cost 
sharing with respect to the coverage or benefits required 
to be provided under section 2708 of the Public Health 
Service Act that is inconsistent with the cost sharing that 
is otherwise permitted under this chapter.’’. 
Æ 
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