[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2812 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 2812

 To amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to require 
 that group and individual health insurance coverage and group health 
     plans provide coverage of screening for breast, prostate, and 
                           colorectal cancer.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 8, 2005

 Mrs. Maloney introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
Education and the Workforce, Ways and Means, and Government Reform, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to require 
 that group and individual health insurance coverage and group health 
     plans provide coverage of screening for breast, prostate, and 
                           colorectal cancer.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cancer Screening Coverage Act of 
2005''.

SEC. 2. CANCER SCREENING COVERAGE.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--
                    (A) In general.--Subpart 2 of part A of title XXVII 
                of the Public Health Service Act (42 U.S.C. 300gg-4 et 
                seq.) is amended by adding at the end the following:

``SEC. 2707. COVERAGE OF CANCER SCREENING.

    ``(a) Requirement.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall provide coverage 
and payment under the plan or coverage for the following items and 
services under terms and conditions that are no less favorable than the 
terms and conditions applicable to other screening benefits otherwise 
provided under the plan or coverage:
            ``(1) Mammograms.--In the case of a female participant or 
        beneficiary who is 40 years of age or older, or is under 40 
        years of age but is at high risk (as defined in subsection (e)) 
        of developing breast cancer, an annual mammography (as defined 
        in section 1861(jj) of the Social Security Act) conducted by a 
        facility that has a certificate (or provisional certificate) 
        issued under section 354.
            ``(2) Clinical breast examinations.--In the case of a 
        female participant or beneficiary who--
                    ``(A)(i) is 40 years of age or older; or
                    ``(ii) is at least 20 (but less than 40) years of 
                age and is at high risk of developing breast cancer, an 
                annual clinical breast examination; or
                    ``(B) is at least 20, but less than 40, years of 
                age and who is not at high risk of developing breast 
                cancer, a clinical breast examination each 3 years.
            ``(3) Pap tests and pelvic examinations.--In the case of a 
        female participant or beneficiary who is 18 years of age or 
        older, or who is under 18 years of age and is or has been 
        sexually active--
                    ``(A) an annual diagnostic laboratory test 
                (popularly known as a `pap smear') consisting of a 
                routine exfoliative cytology test (Papanicolaou test) 
                provided to a woman for the purpose of early detection 
                of cervical or vaginal cancer and including an 
                interpretation by a qualified health professional of 
                the results of the test; and
                    ``(B) an annual pelvic examination.
            ``(4) Colorectal cancer screening procedures.--In the case 
        of a participant or beneficiary who is 50 years of age or 
        older, or who is under 50 years of age and is at high risk of 
        developing colorectal cancer, the procedures described in 
        section 1861(pp)(1) of the Social Security Act (42 U.S.C. 
        1395x(pp)(1)) or section 4104(a)(2) of the Balanced Budget Act 
        of 1997 (111 Stat. 362), shall be furnished to the individual 
        for the purpose of early detection of colorectal cancer. The 
        group health plan or health insurance issuer shall provide 
        coverage for the method and frequency of colorectal cancer 
        screening determined to be appropriate by a health care 
        provider treating such participant or beneficiary, in 
        consultation with the participant or beneficiary.
            ``(5) Prostate cancer screening.--In the case of a male 
        participant or beneficiary who is 50 years of age or older, or 
        who is younger than 50 years of age and is at high risk for 
        prostate cancer (including African American men or a male who 
        has a history of prostate cancer in 1 or more first degree 
        family members), the procedures described in section 
        1861(oo)(2) of Social Security Act (42 U.S.C. 1395x(oo)(2)) 
        shall be furnished to the individual for the early detection of 
        prostate cancer. The group health plan or health insurance 
        issuer shall provide coverage for the method and frequency of 
        prostate cancer screening determined to be appropriate by a 
        health care provider treating such participant or beneficiary, 
        in consultation with the participant or beneficiary.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, shall not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        an individual who is a participant or beneficiary to undergo a 
        procedure, examination, or test described in subsection (a).
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan or issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits described in subsection (a) consistent with such 
        subsection, except that such coinsurance or other cost-sharing 
        shall not discriminate on any basis related to the coverage 
        required under this section.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 714(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
of this section as if such section applied to such plan.
    ``(e) High Risk Defined.--For purposes of this section, an 
individual is considered to be at `high risk' of developing a 
particular type of cancer if, under guidelines developed or recognized 
by the Secretary based upon scientific evidence, the individual--
            ``(1) has 1 or more first degree family members who have 
        developed that type of cancer;
            ``(2) has previously had that type of cancer;
            ``(3) has the presence of an appropriate recognized gene 
        marker that is identified as putting the individual at a higher 
        risk of developing that type of cancer; or
            ``(4) has other predisposing factors that significantly 
        increase the risk of the individual contracting that type of 
        cancer.
For purposes of this subsection, the term `type of cancer' includes 
other types of cancer that the Secretary recognizes as closely related 
for purposes of establishing risk.

``SEC. 2708. PATIENT ACCESS TO INFORMATION.

    ``(a) Disclosure Requirement.--A group health plan, and health 
insurance issuer offering group health insurance coverage shall--
            ``(1) provide to participants and beneficiaries at the time 
        of initial coverage under the plan (or the effective date of 
        this section, in the case of individuals who are participants 
        or beneficiaries as of such date), and at least annually 
        thereafter, the information described in subsection (b) in 
        printed form;
            ``(2) provide to participants and beneficiaries, within a 
        reasonable period (as specified by the appropriate Secretary) 
        before or after the date of significant changes in the 
        information described in subsection (b), information in printed 
        form regarding such significant changes; and
            ``(3) upon request, make available to participants and 
        beneficiaries, the applicable authority, and prospective 
        participants and beneficiaries, the information described in 
        subsection (b) in printed form.
    ``(b) Information Provided.--The information described in 
subsection (a) that shall be disclosed includes the following, as such 
relates to cancer screening required under section 2707(a):
            ``(1) Benefits.--Benefits offered under the plan or 
        coverage, including--
                    ``(A) covered benefits, including benefit limits 
                and coverage exclusions;
                    ``(B) cost sharing, such as deductibles, 
                coinsurance, and copayment amounts, including any 
                liability for balance billing, any maximum limitations 
                on out of pocket expenses, and the maximum out of 
                pocket costs for services that are provided by 
                nonparticipating providers or that are furnished 
                without meeting the applicable utilization review 
                requirements;
                    ``(C) the extent to which benefits may be obtained 
                from nonparticipating providers; and
                    ``(D) the extent to which a participant, 
                beneficiary, or enrollee may select from among 
                participating providers and the types of providers 
                participating in the plan or issuer network.
            ``(2) Access.--A description of the following:
                    ``(A) The number, mix, and distribution of 
                providers under the plan or coverage.
                    ``(B) Out-of-network coverage (if any) provided by 
                the plan or coverage.
                    ``(C) Any point-of-service option (including any 
                supplemental premium or cost-sharing for such option).
                    ``(D) The procedures for participants, 
                beneficiaries, and enrollees to select, access, and 
                change participating primary and specialty providers.
                    ``(E) The rights and procedures for obtaining 
                referrals (including standing referrals) to 
                participating and nonparticipating providers.
                    ``(F) The name, address, and telephone number of 
                participating health care providers and an indication 
                of whether each such provider is available to accept 
                new patients.
                    ``(G) How the plan or issuer addresses the needs of 
                participants, beneficiaries, and enrollees and others 
                who do not speak English or who have other special 
                communications needs in accessing providers under the 
                plan or coverage, including the provision of 
                information under this subsection.''.
                    (B) Technical amendment.--Section 2723(c) of the 
                Public Health Service Act (42 U.S.C. 300gg-23(c)) is 
                amended by striking ``section 2704'' and inserting 
                ``sections 2704 and 2707''.
            (2) ERISA amendments.--
                    (A) In general.--Subpart B of part 7 of subtitle B 
                of title I of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1185 et seq.) is amended by 
                adding at the end the following new section:

``SEC. 714. COVERAGE OF CANCER SCREENING.

    ``(a) Requirement.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall provide coverage 
and payment under the plan or coverage for the following items and 
services under terms and conditions that are no less favorable than the 
terms and conditions applicable to other screening benefits otherwise 
provided under the plan or coverage:
            ``(1) Mammograms.--In the case of a female participant or 
        beneficiary who is 40 years of age or older, or is under 40 
        years of age but is at high risk (as defined in subsection (e)) 
        of developing breast cancer, an annual mammography (as defined 
        in section 1861(jj) of the Social Security Act) conducted by a 
        facility that has a certificate (or provisional certificate) 
        issued under section 354 of the Public Health Service Act.
            ``(2) Clinical breast examinations.--In the case of a 
        female participant or beneficiary who--
                    ``(A)(i) is 40 years of age or older; or
                    ``(ii) is at least 20 (but less than 40) years of 
                age and is at high risk of developing breast cancer, an 
                annual clinical breast examination; or
                    ``(B) is at least 20, but less than 40, years of 
                age and who is not at high risk of developing breast 
                cancer, a clinical breast examination each 3 years.
            ``(3) Pap tests and pelvic examinations.--In the case of a 
        female participant or beneficiary who is 18 years of age or 
        older, or who is under 18 years of age and is or has been 
        sexually active--
                    ``(A) an annual diagnostic laboratory test 
                (popularly known as a `pap smear') consisting of a 
                routine exfoliative cytology test (Papanicolaou test) 
                provided to a woman for the purpose of early detection 
                of cervical or vaginal cancer and including an 
                interpretation by a qualified health professional of 
                the results of the test; and
                    ``(B) an annual pelvic examination.
            ``(4) Colorectal cancer screening procedures.--In the case 
        of a participant or beneficiary who is 50 years of age or 
        older, or who is under 50 years of age and is at high risk of 
        developing colorectal cancer, the procedures described in 
        section 1861(pp)(1) of the Social Security Act (42 U.S.C. 
        1395x(pp)(1)) or section 4104(a)(2) of the Balanced Budget Act 
        of 1997 (111 Stat. 362), shall be furnished to the individual 
        for the purpose of early detection of colorectal cancer. The 
        group health plan or health insurance issuer shall provided 
        coverage for the method and frequency of colorectal cancer 
        screening determined to be appropriate by a health care 
        provider treating such participant or beneficiary, in 
        consultation with the participant or beneficiary.
            ``(5) Prostate cancer screening.--In the case of a male 
        participant or beneficiary who is 50 years of age or older, or 
        who is younger than 50 years of age and is at high risk for 
        prostate cancer (including African American men or a male who 
        has a history of prostate cancer in 1 or more first degree 
        family members), the procedures described in section 
        1861(oo)(2) of Social Security Act (42 U.S.C. 1395x(oo)(2)) 
        shall be furnished to the individual for the early detection of 
        prostate cancer. The group health plan or health insurance 
        issuer shall provide coverage for the method and frequency of 
        prostate cancer screening determined to be appropriate by a 
        health care provider treating such participant or beneficiary, 
        in consultation with the participant or beneficiary.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        an individual who is a participant or beneficiary to undergo a 
        procedure, examination, or test described in subsection (a).
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan or issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits described in subsection (a) consistent with such 
        subsection, except that such coinsurance or other cost-sharing 
        shall not discriminate on any basis related to the coverage 
        required under this section.
    ``(d) Notice Under Group Health Plan.--The imposition of the 
requirement of this section shall be treated as a material modification 
in the terms of the plan described in section 102(a), for purposes of 
assuring notice of such requirements under the plan; except that the 
summary description required to be provided under the last sentence of 
section 104(b)(1) with respect to such modification shall be provided 
by not later than 60 days after the first day of the first plan year in 
which such requirement apply.
    ``(e) High Risk Defined.--For purposes of this section, an 
individual is considered to be at `high risk' of developing a 
particular type of cancer if, under guidelines developed or recognized 
by the Secretary based upon scientific evidence, the individual--
            ``(1) has 1 or more first degree family members who have 
        developed that type of cancer;
            ``(2) has previously had that type of cancer;
            ``(3) has the presence of an appropriate recognized gene 
        marker that is identified as putting the individual at a higher 
        risk of developing that type of cancer; or
            ``(4) has other predisposing factors that significantly 
        increase the risk of the individual contracting that type of 
        cancer.
For purposes of this subsection, the term `type of cancer' includes 
other types of cancer that the Secretary recognizes as closely related 
for purposes of establishing risk.

``SEC. 715. PATIENT ACCESS TO INFORMATION.

    ``(a) Disclosure Requirement.--A group health plan, and health 
insurance issuer offering group health insurance coverage shall--
            ``(1) provide to participants and beneficiaries at the time 
        of initial coverage under the plan (or the effective date of 
        this section, in the case of individuals who are participants 
        or beneficiaries as of such date), and at least annually 
        thereafter, the information described in subsection (b) in 
        printed form;
            ``(2) provide to participants and beneficiaries, within a 
        reasonable period (as specified by the appropriate Secretary) 
        before or after the date of significant changes in the 
        information described in subsection (b), information in printed 
        form regarding such significant changes; and
            ``(3) upon request, make available to participants and 
        beneficiaries, the applicable authority, and prospective 
        participants and beneficiaries, the information described in 
        subsection (b) in printed form.
    ``(b) Information Provided.--The information described in 
subsection (a) that shall be disclosed includes the following, as such 
relates to cancer screening required under section 714(a):
            ``(1) Benefits.--Benefits offered under the plan or 
        coverage, including--
                    ``(A) covered benefits, including benefit limits 
                and coverage exclusions;
                    ``(B) cost sharing, such as deductibles, 
                coinsurance, and copayment amounts, including any 
                liability for balance billing, any maximum limitations 
                on out of pocket expenses, and the maximum out of 
                pocket costs for services that are provided by 
                nonparticipating providers or that are furnished 
                without meeting the applicable utilization review 
                requirements;
                    ``(C) the extent to which benefits may be obtained 
                from nonparticipating providers; and
                    ``(D) the extent to which a participant, 
                beneficiary, or enrollee may select from among 
                participating providers and the types of providers 
                participating in the plan or issuer network.
            ``(2) Access.--A description of the following:
                    ``(A) The number, mix, and distribution of 
                providers under the plan or coverage.
                    ``(B) Out-of-network coverage (if any) provided by 
                the plan or coverage.
                    ``(C) Any point-of-service option (including any 
                supplemental premium or cost-sharing for such option).
                    ``(D) The procedures for participants, 
                beneficiaries, and enrollees to select, access, and 
                change participating primary and specialty providers.
                    ``(E) The rights and procedures for obtaining 
                referrals (including standing referrals) to 
                participating and nonparticipating providers.
                    ``(F) The name, address, and telephone number of 
                participating health care providers and an indication 
                of whether each such provider is available to accept 
                new patients.
                    ``(G) How the plan or issuer addresses the needs of 
                participants, beneficiaries, and enrollees and others 
                who do not speak English or who have other special 
                communications needs in accessing providers under the 
                plan or coverage, including the provision of 
                information under this subsection.''.
                    (B) Technical amendments.--
                            (i) Section 731(c) of the Employee 
                        Retirement Income Security Act of 1974 (29 
                        U.S.C. 1191(c)) is amended by striking 
                        ``section 711'' and inserting ``sections 711 
                        and 714''.
                            (ii) Section 732(a) of the Employee 
                        Retirement Income Security Act of 1974 (29 
                        U.S.C. 1191a(a)) is amended by striking 
                        ``section 711'' and inserting ``sections 711 
                        and 714''.
                            (iii) The table of contents in section 1 of 
                        the Employee Retirement Income Security Act of 
                        1974 is amended by inserting after the item 
                        relating to section 713 the following new 
                        items:

``714. Coverage of cancer screening.
``715. Patient access to information.''.
            (3) Internal revenue code amendments.--Subchapter B of 
        chapter 100 of the Internal Revenue Code of 1986 is amended--
                    (A) in the table of sections, by inserting after 
                the item relating to section 9812 the following new 
                items:

``9813. Coverage of cancer screening.
``9814. Patient access to information.'';
             and
                    (B) by inserting after section 9812 the following:

``SEC. 9813. COVERAGE OF CANCER SCREENING.

    ``(a) Requirement.--A group health plan shall provide coverage and 
payment under the plan for the following items and services under terms 
and conditions that are no less favorable than the terms and conditions 
applicable to other screening benefits otherwise provided under the 
plan:
            ``(1) Mammograms.--In the case of a female participant or 
        beneficiary who is 40 years of age or older, or is under 40 
        years of age but is at high risk (as defined in subsection (d)) 
        of developing breast cancer, an annual mammography (as defined 
        in section 1861(jj) of the Social Security Act) conducted by a 
        facility that has a certificate (or provisional certificate) 
        issued under section 354 of the Public Health Service Act.
            ``(2) Clinical breast examinations.--In the case of a 
        female participant or beneficiary who--
                    ``(A)(i) is 40 years of age or older; or
                    ``(ii) is at least 20 (but less than 40) years of 
                age and is at high risk of developing breast cancer, an 
                annual clinical breast examination; or
                    ``(B) is at least 20, but less than 40, years of 
                age and who is not at high risk of developing breast 
                cancer, a clinical breast examination each 3 years.
            ``(3) Pap tests and pelvic examinations.--In the case of a 
        female participant or beneficiary who is 18 years of age or 
        older, or who is under 18 years of age and is or has been 
        sexually active--
                    ``(A) an annual diagnostic laboratory test 
                (popularly known as a `pap smear') consisting of a 
                routine exfoliative cytology test (Papanicolaou test) 
                provided to a woman for the purpose of early detection 
                of cervical or vaginal cancer and including an 
                interpretation by a qualified health professional of 
                the results of the test; and
                    ``(B) an annual pelvic examination.
            ``(4) Colorectal cancer screening procedures.--In the case 
        of a participant or beneficiary who is 50 years of age or 
        older, or who is under 50 years of age and is at high risk of 
        developing colorectal cancer, the procedures described in 
        section 1861(pp)(1) of the Social Security Act (42 U.S.C. 
        1395x(pp)(1)) or section 4104(a)(2) of the Balanced Budget Act 
        of 1997 (111 Stat. 362), shall be furnished to the individual 
        for the purpose of early detection of colorectal cancer. The 
        group health plan or health insurance issuer shall provide 
        coverage for the method and frequency of colorectal cancer 
        screening determined to be appropriate by a health care 
        provider treating such participant or beneficiary, in 
        consultation with the participant or beneficiary.
            ``(5) Prostate cancer screening.--In the case of a male 
        participant or beneficiary who is 50 years of age or older, or 
        who is younger than 50 years of age and is at high risk for 
        prostate cancer (including African American men or a male who 
        has a history of prostate cancer in 1 or more first degree 
        family members), the procedures described in section 
        1861(oo)(2) of Social Security Act (42 U.S.C. 1395x(oo)(2)) 
        shall be furnished to the individual for the early detection of 
        prostate cancer. The group health plan or health insurance 
        issuer shall provide coverage for the method and frequency of 
        prostate cancer screening determined to be appropriate by a 
        health care provider treating such participant or beneficiary, 
        in consultation with the participant or beneficiary.
    ``(b) Prohibitions.--A group health plan may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        an individual who is a participant or beneficiary to undergo a 
        procedure, examination, or test described in subsection (a).
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan from imposing deductibles, 
        coinsurance, or other cost-sharing in relation to benefits 
        described in subsection (a) consistent with such subsection, 
        except that such coinsurance or other cost-sharing shall not 
        discriminate on any basis related to the coverage required 
        under this section.
    ``(d) High Risk Defined.--For purposes of this section, an 
individual is considered to be at `high risk' of developing a 
particular type of cancer if, under guidelines developed or recognized 
by the Secretary based upon scientific evidence, the individual--
            ``(1) has 1 or more first degree family members who have 
        developed that type of cancer;
            ``(2) has previously had that type of cancer;
            ``(3) has the presence of an appropriate recognized gene 
        marker that is identified as putting the individual at a higher 
        risk of developing that type of cancer; or
            ``(4) has other predisposing factors that significantly 
        increase the risk of the individual contracting that type of 
        cancer.
For purposes of this subsection, the term `type of cancer' includes 
other types of cancer that the Secretary recognizes as closely related 
for purposes of establishing risk.

``SEC. 9814. PATIENT ACCESS TO INFORMATION.

    ``(a) Disclosure Requirement.--A group health plan, and health 
insurance issuer offering group health insurance coverage shall--
            ``(1) provide to participants and beneficiaries at the time 
        of initial coverage under the plan (or the effective date of 
        this section, in the case of individuals who are participants 
        or beneficiaries as of such date), and at least annually 
        thereafter, the information described in subsection (b) in 
        printed form;
            ``(2) provide to participants and beneficiaries, within a 
        reasonable period (as specified by the appropriate Secretary) 
        before or after the date of significant changes in the 
        information described in subsection (b), information in printed 
        form regarding such significant changes; and
            ``(3) upon request, make available to participants and 
        beneficiaries, the applicable authority, and prospective 
        participants and beneficiaries, the information described in 
        subsection (b) in printed form.
    ``(b) Information Provided.--The information described in 
subsection (a) that shall be disclosed includes the following, as such 
relates to cancer screening required under section 9813(a):
            ``(1) Benefits.--Benefits offered under the plan or 
        coverage, including--
                    ``(A) covered benefits, including benefit limits 
                and coverage exclusions;
                    ``(B) cost sharing, such as deductibles, 
                coinsurance, and copayment amounts, including any 
                liability for balance billing, any maximum limitations 
                on out of pocket expenses, and the maximum out of 
                pocket costs for services that are provided by 
                nonparticipating providers or that are furnished 
                without meeting the applicable utilization review 
                requirements;
                    ``(C) the extent to which benefits may be obtained 
                from nonparticipating providers; and
                    ``(D) the extent to which a participant, 
                beneficiary, or enrollee may select from among 
                participating providers and the types of providers 
                participating in the plan or issuer network.
            ``(2) Access.--A description of the following:
                    ``(A) The number, mix, and distribution of 
                providers under the plan or coverage.
                    ``(B) Out-of-network coverage (if any) provided by 
                the plan or coverage.
                    ``(C) Any point-of-service option (including any 
                supplemental premium or cost-sharing for such option).
                    ``(D) The procedures for participants, 
                beneficiaries, and enrollees to select, access, and 
                change participating primary and specialty providers.
                    ``(E) The rights and procedures for obtaining 
                referrals (including standing referrals) to 
                participating and nonparticipating providers.
                    ``(F) The name, address, and telephone number of 
                participating health care providers and an indication 
                of whether each such provider is available to accept 
                new patients.
                    ``(G) How the plan or issuer addresses the needs of 
                participants, beneficiaries, and enrollees and others 
                who do not speak English or who have other special 
                communications needs in accessing providers under the 
                plan or coverage, including the provision of 
                information under this subsection.''.
    (b) Individual Health Insurance.--
            (1) In general.--Part B of title XXVII of the Public Health 
        Service Act is amended by inserting after section 2752 (42 
        U.S.C. 300gg-52) the following new section:

``SEC. 2753. STANDARD RELATING PATIENT FREEDOM OF CHOICE.

    ``(a) In General.--The provisions of section 2707 (other than 
subsection (d)) shall apply to health insurance coverage offered by a 
health insurance issuer in the individual market with respect to an 
enrollee under such coverage in the same manner as they apply to health 
insurance coverage offered by a health insurance issuer in connection 
with a group health plan in the small or large group market to a 
participant or beneficiary in such plan.
    ``(b) Notice.--A health insurance issuer under this part shall 
comply with the notice requirement under section 714(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
referred to in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.

``SEC. 2754. PATIENT ACCESS TO INFORMATION.

    ``The provisions of section 2708 shall apply health insurance 
coverage offered by a health insurance issuer in the individual market 
with respect to an enrollee under such coverage in the same manner as 
they apply to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small or large 
group market to a participant or beneficiary in such plan.''.
            (2) Technical amendment.--Section 2762(b)(2) of such Act 
        (42 U.S.C. 300gg-62(b)(2)) is amended by striking ``section 
        2751'' and inserting ``sections 2751 and 2753''.
    (c) Effective Dates.--
            (1) Group health plans.--Subject to paragraph (3), the 
        amendments made by subsection (a) shall apply with respect to 
        group health plans for plan years beginning on or after January 
        1, 2006.
            (2) Individual plans.--The amendment made by subsection (b) 
        shall apply with respect to health insurance coverage offered, 
        sold, issued, renewed, in effect, or operated in the individual 
        market on or after such date.
            (3) Collective bargaining agreement.--In the case of a 
        group health plan maintained pursuant to 1 or more collective 
        bargaining agreements between employee representatives and 1 or 
        more employers ratified before the date of enactment of this 
        Act, the amendments made to subsection (a) shall not apply to 
        plan years beginning before the later of--
                    (A) the date on which the last collective 
                bargaining agreements relating to the plan terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of enactment of this Act), or
                    (B) January 1, 2006.
        For purposes of subparagraph (A), any plan amendment made 
        pursuant to a collective bargaining agreement relating to the 
        plan which amends the plan solely to conform to any requirement 
        added by subsection (a) shall not be treated as a termination 
        of such collective bargaining agreement.
    (d) Coordinated Regulations.--Section 104(1) of Health Insurance 
Portability and Accountability Act of 1996 (Public Law 104-191) is 
amended by striking ``this subtitle (and the amendments made by this 
subtitle and section 401)'' and inserting ``the provisions of part 7 of 
subtitle B of title I of the Employee Retirement Income Security Act of 
1974, the provisions of parts A and C of title XXVII of the Public 
Health Service Act, and chapter 100 of the Internal Revenue Code of 
1986''.
    (e) Modification of Coverage.--
            (1) In general.--The Secretary of Health and Human Services 
        may modify the coverage requirements for the amendments under 
        this Act to allow such requirements to incorporate and reflect 
        new scientific and technological advances regarding cancer 
        screening, practice pattern changes in such screening, or other 
        updated medical practices regarding such screening, such as the 
        use of new tests or other emerging technologies. Such 
        modifications shall not in any way diminish the coverage 
        requirements listed under this Act. Such modifications may be 
        made on the Secretary's own initiative or upon petition to the 
        Secretary by an individual or organization.
            (2) Consultation.--In modifying coverage requirements under 
        paragraph (1), the Secretary of Health and Human Services shall 
        consult with appropriate organizations, experts, and agencies.
            (3) Petitions.--The Secretary of Health and Human Services 
        may issue requirements for the petitioning process under 
        paragraph (1), including requirements that the petition be in 
        writing and include scientific or medical bases for the 
        modification sought. Upon receipt of such a petition, the 
        Secretary shall respond to the petitioner and decide whether to 
        propose a regulation proposing a change within 90 days of such 
        receipt. If a regulation is required, the Secretary shall 
        propose such regulation within 6 months of such determination. 
        The Secretary shall provide the petitioner the reasons for the 
        decision of the Secretary. The Secretary may make changes 
        requested by a petitioner in whole or in part.

SEC. 3. APPLICATION TO OTHER HEALTH CARE COVERAGE.

    Chapter 89 of title 5, United States Code, is amended by adding at 
the end the following:
``Sec. 8915. Standards relating to coverage of cancer screening and 
              patient access to information
    ``(a) The provisions of sections 2707 and 2708 of the Public Health 
Service Act shall apply to the provision of items and services under 
this chapter.
    ``(b) Nothing in this section or section 2707(c) of the Public 
Health Service Act shall be construed as authorizing a health insurance 
issuer or entity to impose cost sharing with respect to the coverage or 
benefits required to be provided under section 2707 of the Public 
Health Service Act that is inconsistent with the cost sharing that is 
otherwise permitted under this chapter.''.
                                 <all>