‘‘(b) PROTECTIONS.—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 coverage for annual screening mam-
mography or annual magnetic resonance imaging on 
the basis that the coverage is not medically nec-
essary or on the basis that the screening mammog-
raphy or magnetic resonance imaging, respectively, 
is not pursuant to a referral, consent, or rec-
ommendation by any health care provider; 
‘‘(2) 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; 
‘‘(3) provide monetary payments or rebates to 
women to encourage such women to accept less than 
the minimum protections available under this sec-
tion; 
‘‘(4) 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 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
‘‘(5) 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. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
to require a woman who is a participant or bene-
ficiary to undergo annual screening mammography 
or annual magnetic resonance imaging. 
‘‘(2) This section shall not apply with respect to 
any group health plan, or any group health insur-
ance coverage offered by a health insurance issuer, 
which does not provide benefits for diagnostic mam-
mography. 
‘‘(3) 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 for screening mammog-
raphy or magnetic resonance imaging under the plan 
(or under health insurance coverage offered in con-
nection with a group health plan), except that such 
coinsurance or other cost-sharing for any portion of 
such benefits may not be greater than such coinsur-
ance or cost-sharing that is otherwise applicable with 
respect to benefits for diagnostic mammography. 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
‘‘(4) Women should (but are not required to) 
consult with appropriate health care practitioners 
before undergoing screening mammography or mag-
netic resonance imaging, but nothing in this section 
shall be construed as requiring the approval of a 
health care practitioner before a woman undergoes 
an annual screening mammography or annual mag-
netic resonance imaging. 
‘‘(d) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
715(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) 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. 
‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.— 
‘‘(1) SCREENING
MAMMOGRAPHY.—The re-
quirements of this section, with respect to annual 
screening mammography, shall not apply with re-
spect to health insurance coverage for women who 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
are 40 years of age or older or who are high risk 
women if there is a State law (as defined in section 
2723(d)(1)) for a State that regulates such cov-
erage, that requires coverage to be provided for an-
nual screening mammography for women who are 40 
years of age or older or who are high risk women 
(as defined in subsection (a)(2)(B)), respectively, 
and that provides at least the protections described 
in subsection (b). 
‘‘(2) MAGNETIC RESONANCE IMAGING.—The re-
quirements of this section, with respect to annual 
magnetic resonance imaging, shall not apply with re-
spect to health insurance coverage if there is a State 
law (as defined in section 2723(d)(1)) for a State 
that regulates such coverage, that requires coverage 
to be provided for annual magnetic resonance imag-
ing for high risk women (as defined in subsection 
(a)(2)(B)), and that provides at least the protections 
described in subsection (b). 
‘‘(3) CONSTRUCTION.—Section 2723(a)(1) shall 
not be construed as superseding a State law de-
scribed in paragraph (1) or (2).’’. 
(2) Section 2723(c) of such Act (42 U.S.C. 
300gg–23(c)) is amended by striking ‘‘section 2704’’ 
and inserting ‘‘sections 2704 and 2708’’. 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
(b) ERISA AMENDMENTS.— 
(1) Subpart B of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act 
of 1974 is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 715. STANDARDS RELATING TO BENEFITS FOR 
SCREENING MAMMOGRAPHY AND MAGNETIC 
RESONANCE IMAGING. 
‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL 
SCREENING MAMMOGRAPHY
AND ANNUAL MAGNETIC 
RESONANCE IMAGING.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, that provides coverage for diagnostic 
mammography for any woman who is 40 years of 
age or older shall provide coverage for annual 
screening mammography for such a woman and di-
agnostic mammography, annual screening mammog-
raphy, and annual magnetic resonance imaging for 
any high risk woman under terms and conditions 
that are not less favorable than the terms and condi-
tions for coverage of diagnostic mammography for a 
woman who is 40 years of age or older. 
‘‘(2) DEFINITIONS.—For purposes of this sec-
tion— 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
‘‘(A) The term ‘diagnostic mammography’ 
means a radiologic procedure that is medically 
necessary for the purpose of diagnosing breast 
cancer and includes a physician’s interpretation 
of the results of the procedure. 
‘‘(B) The term ‘high risk woman’ means a 
woman who— 
‘‘(i) has a known BRCA1 or BRCA2 
gene mutation; 
‘‘(ii) has a mother, father, brother, 
sister, or child with such a gene mutation 
and has not had genetic testing to deter-
mine the existence of such a gene muta-
tion; 
‘‘(iii) has a lifetime risk of breast can-
cer of 20 percent or greater, according to 
risk assessment tools that are based main-
ly on family history; 
‘‘(iv) had radiation therapy to the 
chest when the woman was between the 
ages of 10 and 30 years of age; 
‘‘(v) 
has 
Li-Fraumeni 
syndrome, 
Cowden syndrome, or Bannayan-Riley- 
Ruvalcaba syndrome, or has a relative de-
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
scribed in clause (ii) who has one of such 
syndromes; or 
‘‘(vi) has another predisposing condi-
tion, as determined by a physician, that 
significantly increases the risk of the 
woman contracting breast cancer. 
‘‘(C) The term ‘screening mammography’ 
means a radiologic procedure provided to a 
woman for the purpose of early detection of 
breast cancer and includes a physician’s inter-
pretation of the results of the procedure. 
‘‘(b) PROTECTIONS.—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 coverage described in subsection 
(a)(1) on the basis that the coverage is not medically 
necessary or on the basis that the screening mam-
mography or magnetic resonance imaging is not pur-
suant to a referral, consent, or recommendation by 
any health care provider; 
‘‘(2) 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; 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
‘‘(3) provide monetary payments or rebates to 
women to encourage such women to accept less than 
the minimum protections available under this sec-
tion; 
‘‘(4) 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 
‘‘(5) 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. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
to require a woman who is a participant or bene-
ficiary to undergo annual screening mammography 
or annual magnetic resonance imaging. 
‘‘(2) This section shall not apply with respect to 
any group health plan, or any group health insur-
ance coverage offered by a health insurance issuer, 
which does not provide benefits for diagnostic mam-
mography. 
‘‘(3) Nothing in this section shall be construed 
as preventing a group health plan or issuer from im-
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
posing deductibles, coinsurance, or other cost-shar-
ing in relation to benefits for screening mammog-
raphy or magnetic resonance imaging under the plan 
(or under health insurance coverage offered in con-
nection with a group health plan), except that such 
coinsurance or other cost-sharing for any portion of 
such benefits may not be greater than such coinsur-
ance or cost-sharing that is otherwise applicable with 
respect to benefits for diagnostic mammography. 
‘‘(4) Women should (but are not required to) 
consult with appropriate health care practitioners 
before undergoing screening mammography or mag-
netic resonance imaging, but nothing in this section 
shall be construed as requiring the approval of a 
health care practitioner before a woman undergoes 
an annual screening mammography or annual mag-
netic resonance imaging. 
‘‘(d) 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 sum-
mary plan described in section 102(a), for purposes of as-
suring 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 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
60 days after the first day of the first plan year in which 
such requirements apply. 
‘‘(e) 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. 
‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.— 
‘‘(1) SCREENING
MAMMOGRAPHY.—The re-
quirements of this section, with respect to annual 
screening mammography for women who are 40 
years of age or older or for high risk women, shall 
not apply with respect to health insurance coverage 
if there is a State law (as defined in section 
731(d)(1)) for a State that regulates such coverage, 
that requires coverage to be provided for annual 
screening mammography for women who are 40 
years of age or older or for high risk women (as de-
fined in subsection (a)(2)(B)), respectively, and that 
provides at least the protections described in sub-
section (b). 
‘‘(2) MAGNETIC RESONANCE IMAGING.—The re-
quirements of this section, with respect to annual 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
magnetic resonance imaging, shall not apply with re-
spect to health insurance coverage if there is a State 
law (as defined in section 731(d)(1)) for a State 
that regulates such coverage, that requires coverage 
to be provided for annual magnetic resonance imag-
ing for high risk women (as defined in subsection 
(a)(2)(B)), and that provides at least the protections 
described in subsection (b). 
‘‘(3) CONSTRUCTION.—Section 731(a)(1) shall 
not be construed as superseding a State law de-
scribed in paragraph (1) or (2).’’. 
(2) Section 731(c) of such Act (29 U.S.C. 
1191(c)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 715’’. 
(3) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 715’’. 
(4) The table of contents in section 1 of such 
Act is amended by inserting after the item relating 
to section 714 the following new item: 
‘‘Sec. 715. Standards relating to benefits for screening mammography and 
magnetic resonance imaging.’’. 
(c) EFFECTIVE DATES.— 
(1) Subject to paragraph (2), the amendments 
made by this section shall apply with respect to 
group health plans (and health insurance coverage 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS
offered in connection with group health plans) for 
plan years beginning on or after 1 year after the 
date of the enactment of this Act. 
(2)(A) In the case of a group health plan main-
tained pursuant to 1 or more collective bargaining 
agreements between employee representatives and 1 
or more employers ratified before the date of the en-
actment of this Act, the amendments made by this 
section shall not apply to plan years beginning be-
fore the later of— 
(i) the date on which the last collec-
tive bargaining agreements relating to the 
plan terminates (determined without re-
gard to any extension thereof agreed to 
after the date of the enactment of this 
Act); or 
(ii) 1 year after the date of the enact-
ment of this Act. 
(B) For purposes of subparagraph (A)(i), any 
plan amendment made pursuant to a collective bar-
gaining agreement relating to the plan which 
amends the plan solely to conform to any require-
ment added by this section shall not be treated as 
a termination of such collective bargaining agree-
ment. 
VerDate Nov 24 2008 
05:44 Feb 13, 2009
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H995.IH
H995
jbell on PROD1PC69 with BILLS