a radiologic procedure for the early detection of
breast cancer provided to an asymptomatic women
using equipment dedicated specifically for mammog-
raphy and at a facility which meets mammography
accreditation standards established by the Secretary
of Health and Human Services for coverage of
screening mammography under the medicare pro-
gram under title XVIII of the Social Security Act.
Such term also includes a physician’s interpretation
of the results of the procedure.
‘‘(2) 
SCREENING
PAP
SMEAR.—The 
term
‘screening pap smear’ means a diagnostic laboratory
test consisting of a routine exfoliative cytology test
(Papanicolaou test) provided to a woman for the
purpose of early detection of cervical cancer and in-
cludes the examination, the laboratory test itself,
and a physician’s interpretation of the results of the
test. If the Secretary of Health and Human Services
establishes qualify standards for facilities furnishing
screening pap smears, such term shall only include
a test if the test is performed in a facility that has
been determined to meet such standards.
‘‘(c) RESTRICTIONS ON COST-SHARING.—The cov-
erage under this section shall not provide for the applica-
tion of deductibles, coinsurance, or other limitations for
low-dose screening mammography or screening pap
smears that are greater than the deductibles, coinsurance,
and limitations that are applied to similar services under
the health insurance coverage or group health plan.
‘‘(d) FREQUENCY
OF COVERAGE
OF SCREENING
MAMMOGRAPHY.—
‘‘(1) IN
GENERAL.—Coverage of low-dose
screening mammography is consistent with this sec-
tion only if it is provided consistent with the follow-
ing periodicity schedule:
‘‘(A) Coverage is made available for one
baseline low-dose screening mammography for
any woman between 35 and 40 years of age.
‘‘(B) Coverage is made available for such
mammography on an annual basis to any
woman who is 50 years of age or older or who
is determined by a physician to be at-risk of
breast cancer (as defined in paragraph (2)).
‘‘(C) Coverage is made available for such
mammography for a woman at least once every
other year.
‘‘(2) AT-RISK OF BREAST CANCER.—For pur-
poses of paragraph (1)(B), a woman is considered to
be ‘at-risk of breast cancer’ if any of the following
is true:
‘‘(A) The woman has a personal history of
breast cancer.
‘‘(B) The woman has a personal history of
biopsy-proven benign breast disease.
‘‘(C) The woman’s mother, sister, or
daughter has or has had breast cancer.
‘‘(D) The woman has not given birth prior
to the age of 30.
‘‘(e) FREQUENCY OF COVERAGE OF SCREENING PAP
SMEARS.—Coverage of screening pap smears is consistent
with this section only if it is provided not more often than
once every year (or more frequently if recommended by
a physician).
‘‘(f) 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 a woman eligibility, or continued
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
women to encourage such women to accept less than
the minimum protections available under this sec-
tion;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because
such provider provided care to an individual partici-
pant or beneficiary in accordance with this section;
or
‘‘(4) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section.
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require a woman who is a partic-
ipant or beneficiary to undergo a screening mammograph
or screening pap smear.
‘‘(h) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
713(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.
‘‘(i) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage from negotiating the level
and type of reimbursement with a provider for care pro-
vided in accordance with this section.
‘‘(j) PREEMPTION.—
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
surance coverage to the extent such State law pro-
vides greater protection to women in relation to the
benefits provided under this section.
‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)), as amended by section 604(b)(2) of
Public Law 104–204, is amended by striking ‘‘sec-
tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.
(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, as amended
by section 702(a) of Public Law 104–204, is amend-
ed by adding at the end the following new section:
‘‘SEC. 713. STANDARDS RELATING TO BENEFITS FOR
SCREENING 
MAMMOGRAPHY 
AND 
PAP
SMEARS.
‘‘(a) REQUIREMENTS FOR COVERAGE OF SCREENING
MAMMOGRAPHY AND PAP SMEARS.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, shall include (consistent with this sec-
tion)—
‘‘(A) coverage for screening pap smears,
and
‘‘(B) coverage for low-dose screening mam-
mography.
‘‘(b) DEFINITIONS RELATING
TO COVERAGE.—In
this section:
‘‘(1) LOW-DOSE SCREENING MAMMOGRAPHY.—
The term ‘low-dose screening mammography’ means
a radiologic procedure for the early detection of
breast cancer provided to an asymptomatic women
using equipment dedicated specifically for mammog-
raphy and at a facility which meets mammography
accreditation standards established by the Secretary
of Health and Human Services for coverage of
screening mammography under the medicare pro-
gram under title XVIII of the Social Security Act.
Such term also includes a physician’s interpretation
of the results of the procedure.
‘‘(2) 
SCREENING
PAP
SMEAR.—The 
term
‘screening pap smear’ means a diagnostic laboratory
test consisting of a routine exfoliative cytology test
‘‘(B) Coverage is made available for such
mammography on an annual basis to any
woman who is 50 years of age or older or who
is determined by a physician to be at-risk of
breast cancer (as defined in paragraph (2)).
‘‘(C) Coverage is made available for such
mammography for a woman at least once every
other year.
‘‘(2) AT-RISK OF BREAST CANCER.—For pur-
poses of paragraph (1)(B), a woman is considered to
be ‘at-risk of breast cancer’ if any of the following
is true:
‘‘(A) The woman has a personal history of
breast cancer.
‘‘(B) The woman has a personal history of
biopsy-proven benign breast disease.
‘‘(C) The woman’s mother, sister, or
daughter has or has had breast cancer.
‘‘(D) The woman has not given birth prior
to the age of 30.
‘‘(e) FREQUENCY OF COVERAGE OF SCREENING PAP
SMEARS.—Coverage of screening pap smears is consistent
with this section only if it is provided not more often than
once every year (or more frequently if recommended by
a physician).
‘‘(f) 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 a woman eligibility, or continued
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
women to encourage such women to accept less than
the minimum protections available under this sec-
tion;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because
such provider provided care to an individual partici-
pant or beneficiary in accordance with this section;
or
‘‘(4) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section.
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require a woman who is a partic-
ipant or beneficiary to undergo a screening mammograph
or screening pap smear.
‘‘(h) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice 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
requirements apply.
‘‘(i) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage from negotiating the level
and type of reimbursement with a provider for care pro-
vided in accordance with this section.
‘‘(j) PREEMPTION.—
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
surance coverage to the extent such State law pro-
vides greater protection to women in relation to the
benefits provided under this section.
‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)), as amended by section 603(b)(1) of Public
Law 104–204, is amended by striking ‘‘section 711’’
and inserting ‘‘sections 711 and 713’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Standards relating to benefits for screening mammography and pap
smears.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act, as amend-
ed by section 605(a) of Public Law 104–204, is amended
by inserting after section 2751 the following new section:
‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR
SCREENING 
MAMMOGRAPHY 
AND 
PAP
SMEARS.
‘‘(a) IN GENERAL.—The provisions of section 2706
(other than subsection (h)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health
insurance coverage offered by a health insurance issuer
in connection with a group health plan in the small or
large group market.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 713(h) 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.
‘‘(c) PREEMPTION.—
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
surance coverage to the extent such State law pro-
vides greater protection to women in relation to the
benefits provided under this section.
‘‘(2) CONSTRUCTION.—Section 2762(a) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)), as added by section 605(b)(3)(B) of
Public Law 104–204, is amended by striking ‘‘section
2751’’ and inserting ‘‘sections 2751 and 2752’’.
(c) EFFECTIVE DATES.—(1) The amendments made
by subsection (a) shall apply with respect to group health
plans for plan years beginning on or after January 1,
1998.
(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 individ-
ual market on or after such date.
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