HB 281 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for prostate cancer screening.

PRINTER'S NO.   224

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 281
                                               Session of
                                                 2025

     INTRODUCED BY McNEILL, HARKINS, KHAN, SCHLOSSBERG, CERRATO,
        KAZEEM AND OTTEN, JANUARY 22, 2025

     REFERRED TO COMMITTEE ON INSURANCE, JANUARY 22, 2025


                                    AN ACT
 1   Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
 2      act relating to insurance; amending, revising, and
 3      consolidating the law providing for the incorporation of
 4      insurance companies, and the regulation, supervision, and
 5      protection of home and foreign insurance companies, Lloyds
 6      associations, reciprocal and inter-insurance exchanges, and
 7      fire insurance rating bureaus, and the regulation and
 8      supervision of insurance carried by such companies,
 9      associations, and exchanges, including insurance carried by
10      the State Workmen's Insurance Fund; providing penalties; and
11      repealing existing laws," in casualty insurance, providing
12      for coverage for prostate cancer screening.
13      The General Assembly of the Commonwealth of Pennsylvania
14   hereby enacts as follows:
15      Section 1.    The act of May 17, 1921 (P.L.682, No.284), known
16   as The Insurance Company Law of 1921, is amended by adding a
17   section to read:
18      Section 635.11.    Coverage for Prostate Cancer Screening.--(a)
19   A health insurance policy offered, issued or renewed in this
20   Commonwealth shall provide coverage for all expenses associated
21   with prostate cancer screenings no less than annually for
22   covered persons who are at least forty years of age and are at
23   high risk of developing prostate cancer based on one of the
 1   following factors:
 2      (1)   diagnosis of the covered person or a first-degree
 3   relative with a genetic alteration or cancer associated with
 4   increased risk of prostate cancer;
 5      (2)   family history of prostate cancer; or
 6      (3)   other factors, if a physician determines that early
 7   detection for prostate cancer is medically appropriate.
 8      (b)   The coverage required under this section shall not be
 9   subject to cost-sharing.
10      (c)   (1)   Except as provided in paragraph (2), the terms in
11   this section shall be given the same meaning as in section 2102.
12      (2)   As used in this section, the following words and phrases
13   shall have the meanings given to them in this subsection unless
14   the context clearly indicates otherwise:
15      "Cost-sharing" means the share of the health care costs
16   covered by a health insurance policy that a covered person pays
17   out-of-pocket. The term includes a deductible, coinsurance,
18   copayment or similar charge. The term does not include a
19   premium, a balance billed amount from an out-of-network provider
20   or the cost of a noncovered service.
21      "Family history of prostate cancer" means that a first-degree
22   relative of a covered person was diagnosed with, developed or
23   died as a result of prostate cancer.
24      "First-degree relative" means a biological parent, full
25   biological sibling or biological child.
26      "Prostate cancer screening" includes prostate-specific
27   antigen tests and digital rectal examinations.
28      Section 2.    This act shall apply as follows:
29            (1)   For health insurance policies for which either rates
30      or forms are required to be filed by the Federal Government

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1     or the Insurance Department, this act shall apply to any
2     policy for which a form or rate is first filed on or after
3     180 days after the effective date of this paragraph.
4         (2)   For health insurance policies for which neither
5     rates nor forms are required to be filed with the Federal
6     Government or the Insurance Department, this act shall apply
7     to any policy issued or renewed on or after 180 days after
8     the effective date of this paragraph.
9     Section 3.    This act shall take effect in 60 days.




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