In casualty insurance, repealing provisions relating to coverage for mammographic examinations and breast imaging and providing for coverage for mammographic examinations, magnetic resonance imaging and other forms of breast imaging.
SB 88 updates Pennsylvania’s insurance code to require health insurance policies offered, issued, or renewed in the Commonwealth to cover breast cancer screening and imaging services without cost sharing. The bill requires coverage for annual mammograms for covered persons age 40 and older, mammograms for younger covered persons when recommended by a physician, and supplemental breast screenings and diagnostic breast examinations for people whose breast cancer risk is at least average risk or higher. The bill defines key terms such as “average risk,” “diagnostic breast examination,” and “supplemental breast screening,” and specifies that supplemental imaging may include standard or abbreviated MRI or ultrasound when MRI is not possible.
The bill repeals the prior section of the Insurance Company Law of 1921 on mammographic examinations and breast imaging and replaces it with a new section that broadens and modernizes the coverage mandate. It also requires insurers to verify that mammography facilities are properly certified before payment, preserves utilization review, and allows deductibles, copays, or coinsurance for services beyond the minimum required coverage. The bill excludes certain policy types, such as accident-only, dental, vision, Medicare supplement, workers’ compensation, and other limited or specialized coverage forms. The new requirements apply to policies filed or renewed beginning 180 days after the effective date, with the act itself taking effect in 60 days.
The overall sentiment around SB 88 appears strongly supportive and bipartisan. The bill advanced through the Senate Banking and Insurance Committee, Senate Appropriations Committee, and Senate floor with unanimous or near-unanimous votes, and it later passed the House with overwhelming support despite a small number of no votes. The voting record suggests broad agreement that the bill addresses an important women’s health and preventive care issue.
The main points of contention are limited in the available record, but the bill’s structure shows some policy balancing. It mandates no-cost coverage for specified breast imaging services, while still preserving insurer utilization review and cost-sharing for services beyond the minimum required. The definition of who qualifies for supplemental screening, especially the detailed “average risk” standard and the use of risk factors such as dense breast tissue, BRCA mutations, and family history, may be the most technically significant aspect of the bill, though no specific objections are recorded in the provided materials.
SB 88 amends the Pennsylvania Insurance Company Law of 1921 by repealing the prior breast imaging coverage provision and replacing it with a new section that expands and clarifies mandatory health insurance coverage for mammograms, supplemental breast screenings, and diagnostic breast examinations. It affects health insurance policies in the individual and group markets, subject to applicable federal law, and sets minimum coverage standards that insurers must provide without cost sharing for covered breast imaging services. The bill also imposes certification verification requirements for mammography facilities and establishes effective-date rules for newly filed or renewed policies.
The bill’s legislative history shows very strong support. It moved through committee and both chambers with large bipartisan majorities, including unanimous committee votes in the Senate and a 50-0 Senate floor passage, followed by overwhelming House approval. The vote pattern indicates that lawmakers broadly viewed the measure as a straightforward preventive health coverage expansion with clear public health benefits.
No major controversy is reflected in the available transcripts or votes, but the bill does include several policy tradeoffs that could draw attention. Insurers retain utilization review authority and may still apply deductibles or copays to breast imaging services beyond the minimum mandated coverage, which suggests an effort to limit cost exposure while expanding benefits. The detailed definitions of risk categories, especially the “average risk” standard and the inclusion of dense breast tissue, genetic mutations, and family history, are the most technically complex parts of the bill and could be the focus of implementation questions. The bill also excludes certain policy types, such as Medicare supplement and workers’ compensation coverage, which narrows its scope.