I 
109TH CONGRESS 
1ST SESSION H. R. 2812 
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 
JUNE 8, 2005 
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 the Workforce, Ways and Means, and Government Re-
form, 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 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,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Cancer Screening Cov-
erage Act of 2005’’. 
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. 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. 
‘‘(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, 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.
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
‘‘(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 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. 2708. 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;