I
107TH CONGRESS
1ST SESSION
H. R. 1809
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
MAY 10, 2001
Mrs. MALONEY of New York (for herself, Mrs. KELLY, Mr. RANGEL, Mr. GIL-
MAN, Mr. BONIOR, Mr. QUINN, Mr. FROST, Mr. SMITH of New Jersey,
Ms. PELOSI, Mrs. MORELLA, Mr. TOWNS, Mr. WYNN, Mr. OBERSTAR,
Mrs. MINK of Hawaii, Ms. WOOLSEY, Mr. BALDACCI, Mr. GONZALEZ,
Mr. LANGEVIN, Mrs. THURMAN, Ms. MILLENDER-MCDONALD, Mr.
HASTINGS of Florida, Ms. LEE, Mr. HILLIARD, Mr. LEWIS of Georgia,
Mr. LANTOS, Mr. CUMMINGS, Mr. WEXLER, Ms. JACKSON-LEE of Texas,
Mrs. TAUSCHER, Mr. CAPUANO, Ms. HARMAN, Mr. MEEKS of New York,
and Mr. KILDEE) introduced the following bill; which was referred to the
Committee 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 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 2001’’.
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.
‘‘(6) OTHER TESTS AND PROCEDURES.—Such
other tests or procedures for the detection of cancer,
and modifications to the tests and procedures, with
such frequency, as the Secretary determines to be
appropriate, in consultation with appropriate organi-
zations and agencies, for the diagnosis or detection
of cancer.
‘‘(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 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.
‘‘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;
‘‘(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 2707(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-
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
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 2707’’.
(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. 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, 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
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.
‘‘(6) OTHER TESTS AND PROCEDURES.—Such
other tests or procedures for the detection of cancer,
and modifications to the tests and procedures, with
such frequency, as the Secretary determines to be
appropriate, in consultation with appropriate organi-
zations and agencies, for the diagnosis or detection
of 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), 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
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.
‘‘SEC. 715. 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 714(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-
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
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 714’’.
(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 714’’.
(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 713 the
following new items:
‘‘Sec. 714. Coverage of cancer screening.’’.
‘‘Sec. 715. Patient access to information.’’.
(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 items:
‘‘Sec. 9813. Coverage of cancer screening.
‘‘Sec. 9814. Patient access to information.’’;
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, 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.
‘‘(6) OTHER TESTS AND PROCEDURES.—Such
other tests or procedures for the detection of cancer,
and modifications to the tests and procedures, with
such frequency, as the Secretary determines to be
appropriate, in consultation with appropriate organi-
zations and agencies, for the diagnosis or detection
of 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 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 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.
‘‘SEC. 9814. 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 9813(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-
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
accessing providers under the plan or coverage,
including the provision of information under
this subsection.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—
(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. 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.
‘‘SEC. 2754. PATIENT ACCESS TO INFORMATION.
‘‘The provisions of section 2708 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
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 2753’’.
(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, 2002.
(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
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, 2002.
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.—
(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
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 2707 and 2708 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 2707(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 2707 of the Public Health
Service Act that is inconsistent with the cost sharing that
is otherwise permitted under this chapter.’’.
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