‘‘(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; 
‘‘(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-
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 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. 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