This bill amends the Insurance Company Law of 1921 by repealing the existing provisions related to coverage for mammographic examinations and breast imaging, specifically Section 632, and replacing it with a new section, Section 632.1. The new section mandates that health insurance policies in Pennsylvania must provide coverage without cost-sharing for annual mammographic examinations for individuals aged 40 and older, as well as for those under 40 upon a physician's recommendation. Additionally, it requires coverage for supplemental breast screenings and diagnostic breast examinations for individuals determined to be at least at average risk for breast cancer.

The bill also stipulates that insurers must verify the certification of facilities providing mammograms and allows for the application of utilization review and cost-sharing provisions for services beyond the minimum coverage requirements. It clarifies definitions related to average risk, diagnostic breast examinations, and supplemental breast screenings. The act will take effect 60 days after its passage and will apply to health insurance policies issued or renewed after a specified period following its effective date.

Statutes/Laws affected:
Printer's No. 915 (Jun 06, 2025): P.L.682, No.284
Printer's No. 981 (Jun 23, 2025): P.L.682, No.284