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May 31, 2005 • Volume 2 / Number 22 E-Mail This Document  |  Download PDF  |  Bulletin Archive/Search  |  Subscribe

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Community UpdateCommunity Update

An Overview of States with Laws Related to Third-Party Coverage for Cervical Cancer Screening (as of September 30, 2004)

NCI's State Cancer Legislative Database Program (SCLD) contains information synthesized from state-level laws. SCLD does not contain state-level regulations; measures implemented by counties, cities, or other localities; case law; Attorneys General opinions; or data addressing the implementation of state laws - all of which may vary significantly from the laws reported herein. For more information, go to

A Pap test (also known as a Pap smear) and a pelvic exam are important elements of a woman's routine health care services because these tests can detect cancer or abnormalities that may lead to cancer of the cervix.

In 1987, Massachusetts became the first state to enact a law requiring specific third-party payers (insurers) to provide coverage for annual cytologic screening for cervical cancer for women ages 18 and older. Since that time, 24 other states and the District of Columbia (collectively, states) have enacted similar laws. The laws in New Jersey and Ohio differ slightly in that they require certain insurers to provide coverage for cervical cancer screening, while other specified insurers must only offer such coverage. Of the 26 states that require coverage for cervical cancer screening, 7 - California, Georgia, Kansas, Maine, New Jersey, New Mexico, and South Carolina - have laws specifying that coverage for screening is dependent upon physician referral. Laws in all 26 states that require cervical cancer screening coverage specifically mandate coverage for the Pap test. Of those states, nine also require screening to include coverage for a pelvic/clinical examination.

The American Cancer Society (ACS) recommends that cervical cancer screening should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than 21 years of age. Presently, three states - Missouri, North Carolina, and Rhode Island - require coverage that conforms to ACS's cervical cancer screening and surveillance guidelines and one state - Georgia - requires screening to conform to the guidelines published by the College of American Pathologists. North Carolina requires coverage to conform to the ACS guidelines, or those established by the North Carolina Advisory Committee on Cancer Coordination and Control. The age and screening frequency coverage requirements mandated in the other 22 states that require such coverage vary. Eight states specify that coverage for screening must begin at age 18, and one state - New Jersey - requires screening coverage to begin at age 20. Thirteen states do not specify age guidelines for testing.

Testing frequency mandates in the states that require cervical cancer screening coverage are similar. Sixteen states require that annual cervical cancer screening be covered by specified insurers. New Jersey law mandates the provision and offer of coverage by certain insurers every 2 years. Furthermore, laws in the District of Columbia, New Jersey, Oregon, and West Virginia specify that coverage is required for more frequent testing if it is recommended by a physician. The laws in 12 states specify that required cervical cancer screening coverage is to be (or that coverage may be) subject to copayment, deductibles, and/or coinsurance.