PRINTER'S NO. 2259
No. 1760 Session of 1985
INTRODUCED BY GREENWOOD, BELFANTI, FOX, TRELLO, E. Z. TAYLOR AND
HOWLETT, OCTOBER 15, 1985
REFERRED TO COMMITTEE ON INSURANCE, OCTOBER 15, 1985
AN ACT
1 Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2 act relating to insurance; amending, revising, and
3 consolidating the law providing for the incorporation of
4 insurance companies, and the regulation, supervision, and
5 protection of home and foreign insurance companies, Lloyds
6 associations, reciprocal and inter-insurance exchanges, and
7 fire insurance rating bureaus, and the regulation and
8 supervision of insurance carried by such companies,
9 associations, and exchanges, including insurance carried by
10 the State Workmen's Insurance Fund; providing penalties; and
11 repealing existing laws," providing for group rehabilitation
12 policies.
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. Section 621.2 of the act of May 17, 1921
16 (P.L.682, No.284), known as The Insurance Company Law of 1921,
17 is amended by adding a subsection to read:
18 Section 621.2. Group Accident and Sickness Insurance.--* * *
19 (e) A group policy delivered or issued for delivery in this
20 State which provides hospital, surgical or major medical expense
21 insurance or any combination of these coverages on an expense
22 incurred or for service rendered reimbursement basis, excluding
1 a policy which provides indemnity benefits or benefits for
2 specific diseases or accidental injuries only, shall be subject
3 to the following conditions:
4 (1) It shall be applicable to all employes and covered
5 defendants who are or may become neurologically impaired during
6 the currency of the policy. Benefits payable under this
7 provision shall not duplicate any benefits paid or payable under
8 the policy or of any other group contract under which the
9 employe or covered defendant may be insured.
10 (2) The policy shall cover all reasonable and necessary
11 expenses:
12 (i) for the services of a registered nurse or other person
13 of comparable qualifications for the coordination of
14 rehabilitation services, including therapies, modalities and
15 other treatment which are determined to be necessary for the
16 rehabilitation of the employe or defendant;
17 (ii) for transportation to and from a rehabilitation
18 facility in the United States or Canada which is equipped and
19 staffed to treat the specific conditions;
20 (iii) for treatment in a rehabilitation or other facility
21 equipped and staffed to treat the specific condition;
22 (iv) for vocational testing and training for the purpose of
23 making the employe or defendant capable of performing those
24 functions essential to his or her occupation prior to the
25 impairment or for a new occupation for which the employe or
26 defendant would be suitably qualified given the nature of such
27 impairment and the education, training and experience of such
28 employe or defendant; and
29 (v) for supportive equipment and material, including site
30 modification to the permanent residence of the employe or
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1 defendant and including modification of any motor vehicle,
2 provided such equipment, material or modifications are
3 reasonable and necessary to permit the employe or defendant
4 access and function. This provision shall be limited to not
5 exceeding $50,000 in cost and shall not be applicable to the
6 cost of purchase of real estate, improvements to real property
7 or the purchase of a motor vehicle, but shall be applicable to
8 such reasonable and necessary modification of such property.
9 (3) The insurer shall not be liable to costs in excess of
10 $300,000 in the aggregate nor for the cost of treatment incurred
11 in excess of sixty months or five years following the date
12 treatment was initially commenced.
13 Section 2. This act shall take effect in 60 days.
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