HB 1123 — 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, further providing for coverage for colorectal cancer screening.

PRINTER'S NO.   1251

                        THE GENERAL ASSEMBLY OF PENNSYLVANIA



                            HOUSE BILL
                            No. 1123
                                                  Session of
                                                    2025

     INTRODUCED BY GALLAGHER, J.HARRIS, KHAN, DOUGHERTY, MADDEN,
        PROBST, WAXMAN, GIRAL, HILL-EVANS, PIELLI, HANBIDGE, CIRESI,
        HOHENSTEIN, GUENST, WARREN, CEPEDA-FREYTIZ, OTTEN,
        SCHLOSSBERG, DONAHUE, McNEILL, SANCHEZ, T. DAVIS, STEELE,
        GREEN, FREEMAN, CURRY, McANDREW, NEILSON, BOROWSKI, CERRATO,
        RIVERA, MALAGARI, SCOTT, D. WILLIAMS AND O'MARA,
        APRIL 3, 2025

     REFERRED TO COMMITTEE ON INSURANCE, APRIL 3, 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, further
12      providing for coverage for colorectal cancer screening.
13      The General Assembly of the Commonwealth of Pennsylvania
14   hereby enacts as follows:
15         Section 1.    Section 635.3 of the act of May 17, 1921
16   (P.L.682, No.284), known as The Insurance Company Law of 1921,
17   is amended to read:
18         Section 635.3.    Coverage for Colorectal Cancer Screening.--
19   (a)    Except to the extent already covered under another policy,
20   all health insurance policies as defined in this section shall
 1   also provide coverage for colorectal cancer screening for
 2   covered individuals in accordance with American Cancer Society
 3   guidelines for colorectal cancer screening published as of
 4   [January 1, 2008] May 30, 2018, and consistent with approved
 5   medical standards and practices[.] in accordance with the
 6   following:
 7      (1)    Coverage for nonsymptomatic covered individuals who are
 8   [fifty (50)] forty-five (45) years of age or older shall
 9   include, but not be limited to:
10      (i)    An annual fecal occult blood test or fecal
11   immunochemical test.
12      (ii)    A sigmoidoscopy, a screening barium enema or a test
13   consistent with approved medical standards and practices to
14   detect colon cancer, at least once every five (5) years.
15      (iii)     A colonoscopy at least once every ten (10) years.
16      (2)    Coverage for symptomatic covered individuals shall
17   include a colonoscopy, sigmoidoscopy or any combination of
18   colorectal cancer screening tests at a frequency determined by a
19   treating physician.
20      (3)    Coverage for nonsymptomatic covered individuals who are
21   at high or increased risk for colorectal cancer who are under
22   [fifty (50)] forty-five (45) years of age shall include a
23   colonoscopy or any combination of colorectal cancer screening
24   tests in accordance with the American Cancer Society guidelines
25   on screening for colorectal cancer published as of [January 1,
26   2008] May 30, 2018.
27      (b)    The coverage required under this section shall be
28   subject to annual deductibles, coinsurance and copayment
29   requirements imposed by an entity subject to this section for
30   similar coverages under the same health insurance policy or

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 1   contract.
 2      (c)    For the purpose of this section:
 3      (1)    "Health insurance policy" [means any group health,
 4   sickness or accident policy or subscriber contract or
 5   certificate offered to groups of fifty-one (51) or more employes
 6   issued by an entity subject to any one of the following:
 7      (i)    This act.
 8      (ii)     The act of December 29, 1972 (P.L.1701, No.364), known
 9   as the "Health Maintenance Organization Act."
10      (iii)     40 Pa.C.S. Ch. 61 (relating to hospital plan
11   corporations) or 63 (relating to professional health services
12   plan corporations).] as follows:
13      (i)    A policy, subscriber contract, certificate or plan
14   issued by an insurer that provides medical or health care
15   coverage.
16      (ii)     The term does not include accident only, fixed
17   indemnity, limited benefit, credit, dental, vision, specified
18   disease, Medicare supplement, Civilian Health and Medical
19   Program of the Uniformed Services (CHAMPUS) supplement, long-
20   term care or disability income, workers' compensation or
21   automobile medical payment insurance.
22      (2)    "Colonoscopy" means an examination of the rectum and the
23   entire colon using a lighted instrument called a colonoscope.
24      (3)    "Colorectal cancer screening" means any of the following
25   procedures that are furnished to an individual for the purpose
26   of early detection of colorectal cancer:
27      (i)    Screening fecal-occult blood or fecal immunochemical
28   test.
29      (ii)     Screening flexible sigmoidoscopy.
30      (iii)     Screening colonoscopy.

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 1      (iv)    Screening barium enema.
 2      (v)    [Screening test consistent with approved medical
 3   standards and practices to detect colon cancer] CT colonography.
 4      (vi)    Multi-target stool DNA test.
 5      (vii)    Screening test consistent with approved medical
 6   standards and practices to detect colon cancer.
 7      (4)    "Nonsymptomatic person at high or increased risk" means
 8   an individual who poses a higher than average risk for
 9   colorectal cancer according to the American Cancer Society
10   guidelines on screening for colorectal cancer as of [January 1,
11   2008] May 30, 2018.
12      (5)    "Symptomatic person" means an individual who experiences
13   a change in bowel habits, rectal bleeding or persistent stomach
14   cramps, weight loss or abdominal pain.
15      (6)    "Insurer" means an entity licensed by the Insurance
16   Department that offers, issues or renews an individual or group
17   health insurance policy that is offered or governed under any of
18   the following:
19      (i)    This act, including section 630 and Article XXIV.
20      (ii)    The act of December 29, 1972 (P.L.1701, No.364), known
21   as the "Health Maintenance Organization Act."
22      (iii)    40 Pa.C.S. Ch. 61 (relating to hospital plan
23   corporations) or 63 (relating to professional health services
24   plan corporations).
25      Section 2.     This act shall apply as follows:
26             (1)   For health insurance policies for which either rates
27      or forms are required to be filed with the Federal Government
28      or the Insurance Department, this act shall apply to any
29      policy for which a form or rate is first filed on or after
30      the effective date of this paragraph.

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




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