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
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 colorectal cancer screening.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 635.3 of the act of May 17, 1921
(P.L.682, No.284), known as The Insurance Company Law of 1921,
is amended to read:
Section 635.3. Coverage for Colorectal Cancer Screening.--
(a) Except to the extent already covered under another policy,
all health insurance policies as defined in this section shall
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20 also provide coverage for colorectal cancer screening for
covered individuals in accordance with American Cancer Society
guidelines for colorectal cancer screening published as of
[January 1, 2008] May 30, 2018, and consistent with approved
medical standards and practices[ .] in accordance with the
following:
(1) Coverage for nonsymptomatic covered individuals who are
[fifty (50)] forty-five (45) years of age or older shall
include, but not be limited to:
(i) An annual fecal occult blood test or fecal
immunochemical test.
(ii) A sigmoidoscopy, a screening barium enema or a test
consistent with approved medical standards and practices to
detect colon cancer, at least once every five (5) years.
(iii) A colonoscopy at least once every ten (10) years.
(2) Coverage for symptomatic covered individuals shall
include a colonoscopy, sigmoidoscopy or any combination of
colorectal cancer screening tests at a frequency determined by a
treating physician.
(3) Coverage for nonsymptomatic covered individuals who are
at high or increased risk for colorectal cancer who are under
[fifty (50)] forty-five (45) years of age shall include a
colonoscopy or any combination of colorectal cancer screening
tests in accordance with the American Cancer Society guidelines
on screening for colorectal cancer published as of [ January 1,
2008] May 30, 2018.
(b) The coverage required under this section shall be
subject to annual deductibles, coinsurance and copayment
requirements imposed by an entity subject to this section for
similar coverages under the same health insurance policy or
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30 contract.
(c) For the purpose of this section:
(1) "Health insurance policy" [ means any group health,
sickness or accident policy or subscriber contract or
certificate offered to groups of fifty-one (51) or more employes
issued by an entity subject to any one of the following:
(i) This act.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).] as follows:
(i) A policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage.
(ii) The term does not include accident only, fixed
indemnity, limited benefit, credit, dental, vision, specified
disease, Medicare supplement, Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) supplement, long-
term care or disability income, workers' compensation or
automobile medical payment insurance.
(2) "Colonoscopy" means an examination of the rectum and the
entire colon using a lighted instrument called a colonoscope.
(3) "Colorectal cancer screening" means any of the following
procedures that are furnished to an individual for the purpose
of early detection of colorectal cancer:
(i) Screening fecal-occult blood or fecal immunochemical
test.
(ii) Screening flexible sigmoidoscopy.
(iii) Screening colonoscopy.
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30 (iv) Screening barium enema.
(v) [Screening test consistent with approved medical
standards and practices to detect colon cancer ] CT colonography.
(vi) Multi-target stool DNA test.
(vii) Screening test consistent with approved medical
standards and practices to detect colon cancer.
(4) "Nonsymptomatic person at high or increased risk" means
an individual who poses a higher than average risk for
colorectal cancer according to the American Cancer Society
guidelines on screening for colorectal cancer as of [ January 1,
2008] May 30, 2018.
(5) "Symptomatic person" means an individual who experiences
a change in bowel habits, rectal bleeding or persistent stomach
cramps, weight loss or abdominal pain.
(6) "Insurer" means an entity licensed by the Insurance
Department that offers, issues or renews an individual or group
health insurance policy that is offered or governed under any of
the following:
(i) This act, including section 630 and Article XXIV.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
Section 2. 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 paragraph.
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30 (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 paragraph.
Section 3. This act shall take effect in 60 days.
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