2023 Pennsylvania Consolidated & Unconsolidated Statutes › Act 1 - INSURANCE COMPANY LAW OF 1921 - COVERAGE FOR MAMMOGRAPHIC EXAMINATIONS AND DIAGNOSTIC BREAST IMAGING AND COVERAGE FOR BRCA-RELATED GENETIC COUNSELING AND GENETIC TESTING

Session of 2023
No. 2023-1
SB 8
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An act relating to insurance;
            amending, revising, and consolidating the law providing for the incorporation of insurance
            companies, and the regulation, supervision, and protection of home and foreign insurance
            companies, Lloyds associations, reciprocal and inter-insurance exchanges, and fire
            insurance rating bureaus, and the regulation and supervision of insurance carried
            by such companies, associations, and exchanges, including insurance carried by the
            State Workmen's Insurance Fund; providing penalties; and repealing existing laws,"
            in casualty insurance, further providing for coverage for mammographic examinations
            and diagnostic breast imaging and providing for coverage for BRCA-related genetic
            counseling and genetic testing.
The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:
Section 1.  Section 632 heading and (b) of the act of May 17, 1921 (P.L.682, No.284), known as
            The Insurance Company Law of 1921, are amended and the section is amended by adding
            a subsection to read:
Section 632.  Coverage for Mammographic Examinations and [Diagnostic] Breast Imaging.--* * *
(b)  A group or individual health or sickness or accident insurance policy providing hospital
            or medical/surgical coverage and a group or individual subscriber contract or certificate
            issued by any entity subject to 40 Pa.C.S. Ch. 61 or 63, this act, the "Health Maintenance
            Organization Act," the "Fraternal Benefit Society Code" or an employe welfare benefit
            plan as defined in section 3 of the Employee Retirement Income Security Act of 1974
            providing hospital or medical/surgical coverage shall also provide coverage for breast
            imaging. The minimum coverage required shall include [supplemental magnetic resonance
            imaging or, if such imaging is not possible, ultrasound if recommended by the treating
            physician]
all costs associated with one supplemental breast screening every year
because the woman is believed to be at an increased risk of breast cancer due to:
(1)  personal history of atypical breast histologies;
(2)  personal history or family history of breast cancer;
(3)  genetic predisposition for breast cancer;
(4)  prior therapeutic thoracic radiation therapy;
(5)  heterogeneously dense breast tissue based on breast composition categories [of the
            Breast Imaging and Reporting Data System established by the American College of Radiology]
            with any one of the following risk factors:
(i)  lifetime risk of breast cancer of greater than 20%, according to risk assessment tools
            based on family history;
(ii)  personal history of BRCA1 or BRCA2 gene mutations;
(iii)  first-degree relative with a BRCA1 or BRCA2 gene mutation but not having had genetic
            testing herself;
(iv)  prior therapeutic thoracic radiation therapy between 10 and 30 years of age; or
(v)  personal history of Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba
            syndrome or a first-degree relative with one of these syndromes[.]
; or
(6)  extremely dense breast tissue based on breast composition [categories of the Breast
            Imaging and Reporting Data System established by the American College of Radiology.
            Nothing in this subsection shall be construed to require an insurer to cover the surgical
            procedure known as mastectomy or to prevent the application of deductible, copayment
            or coinsurance provisions contained in the policy or plan.]
categories.
Nothing in this subsection shall be construed as to preclude utilization review as
            provided under Article XXI of this act or to prevent the application of deductible,
            copayment or coinsurance provisions contained in the policy or plan for breast imaging
            in excess of the minimum coverage required.
* * *
(d)  As used in this section:
"Supplemental breast screening" means a medically necessary and clinically appropriate
            examination of the breast using either standard or abbreviated magnetic resonance
            imaging or, if such imaging is not possible, ultrasound if recommended by the treating
            physician to screen for breast cancer when there is no abnormality seen or suspected
            in the breast.
Section 2.  The act is amended by adding a section to read:
Section 633.1.  Coverage for BRCA-related Genetic Counseling and Genetic Testing.--(a)  A health insurance policy offered, issued or renewed in this Commonwealth shall provide
            coverage for BRCA-related genetic counseling and genetic testing provided by an individual
            licensed, certified or otherwise regulated to provide genetic counseling and genetic
            testing under the laws of this Commonwealth. The minimum coverage required shall include
            all costs associated with genetic counseling and, if indicated after genetic counseling,
            a genetic laboratory test of the BRCA1 and BRCA2 genes for individuals assessed to
            be at an increased risk, based on a clinical risk assessment tool, of potentially
            harmful mutations in the BRCA1 or BRCA2 genes due to a personal or family history
            of breast or ovarian cancer.
(b)  As used in this section:
"Genetic counseling" means the provision of services to individuals, couples, families
            and organizations by one or more appropriately trained individuals to address the
            physical and psychological issues associated with the occurrence or risk of occurrence
            of a genetic disorder, birth defect or genetically influenced condition or disease
            in an individual or a family.
"Health insurance policy" means an individual or group insurance policy, subscriber
            contract, certificate or plan issued by an insurer that provides medical or health
            care coverage, including emergency services. The term does not include any of the
            following:
(1)  An accident only policy.
(2)  A credit only policy.
(3)  A long-term care or disability income policy.
(4)  A specified disease policy.
(5)  A Medicare supplement policy.
(6)  A fixed indemnity policy.
(7)  A hospital indemnity policy.
(8)  A dental only policy.
(9)  A vision only policy.
(10)  A worker's compensation policy.
(11)  An automobile medical payment policy.
(12)  A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed
            Services (CHAMPUS) supplement policy.
(13)  Any other similar policy providing for limited benefits.
"Insurer" means an entity licensed by the Insurance Department with accident and health
            authority to issue a health insurance policy that is offered or governed under any
            of the following:
(1)  This act, including section 630 and Article XXIV.
(2)  The act of December 29, 1972 (P.L.1701, No.364), known as the "Health Maintenance
            Organization Act."
(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional
            health services plan corporations).
Section 3.  This act shall apply as follows:
(1)  For health insurance policies for which either rates or forms are required to be filed
            with the Federal Government or the Insurance Department, this act shall apply to any
            policy for which a form or rate is first filed on or after the effective date of this
            section.
(2)  For health insurance policies for which neither rates nor forms are required to be
            filed with the Federal Government or the Insurance Department, this act shall apply
            to any policy issued or renewed on or after 180 days after the effective date of this
            section.
Section 4.  This act shall take effect in 60 days.
APPROVED--The 1st day of May, A.D. 2023.
JOSH SHAPIRO