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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| SENATE BILL |
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| INTRODUCED BY LEACH, HUGHES, FERLO, WASHINGTON, TARTAGLIONE AND FARNESE, NOVEMBER 10, 2009 |
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| REFERRED TO BANKING AND INSURANCE, NOVEMBER 10, 2009 |
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| AN ACT |
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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 coverage for eating |
12 | disorder treatment. |
13 | The General Assembly of the Commonwealth of Pennsylvania |
14 | hereby enacts as follows: |
15 | Section 1. The act of May 17, 1921 (P.L.682, No.284), known |
16 | as The Insurance Company Law of 1921, is amended by adding a |
17 | section to read: |
18 | Section 635.4. Coverage for Eating Disorder Treatment.--(a) |
19 | All health insurance policies as defined in this section shall |
20 | provide coverage for treatment of eating disorders, including |
21 | coverage for residential treatment of eating disorders, if such |
22 | treatment is medically necessary in accordance with the practice |
23 | guidelines for the treatment of patients with eating disorders, |
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1 | as most recently published by the American Psychiatric |
2 | Association. |
3 | (b) A health insurance policy and an insurer shall not: |
4 | (1) deny to an individual eligibility, or continued |
5 | eligibility, to enroll or to renew coverage under the terms of |
6 | the health insurance policy, solely for the purpose of avioding |
7 | the requirement of this section; |
8 | (2) provide monetary payments, rebates or other benefits to |
9 | an individual to encourage the individual to accept less than |
10 | the minimum protections available under this section; |
11 | (3) penalize or otherwise reduce or limit the reimbursement |
12 | of a provider because the provider provided care to an |
13 | individual participant or beneficiary in accordance with this |
14 | section; |
15 | (4) provide incentives, monetary or otherwise, to a provider |
16 | to induce the provider to provide care to an individual |
17 | participant or beneficiary in a manner inconsistent with this |
18 | section; or |
19 | (5) deny to an individual participant or beneficiary |
20 | continued eligibility to enroll or to renew coverage under the |
21 | terms of the policy solely because the individual was previously |
22 | found to have an eating disorder or to have received treatment |
23 | for an eating disorder. |
24 | (c) Nothing in this section may be construed as preventing a |
25 | health insurance policy from imposing deductibles, coinsurance |
26 | or other cost-sharing in relation to treatment for eating |
27 | disorders, except that the deductibles, coinsurance or other |
28 | cost-sharing shall not be greater than the deductibles, |
29 | coinsurance or other cost-sharing imposed on other comparable |
30 | medical or surgical services covered under the policy. |
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1 | (d) For the purpose of this section: |
2 | (1) "Eating disorder" means anorexia nervosa, bulimia |
3 | nervosa and eating disorders not otherwise specified, including |
4 | binge eating disorder, as defined in the most recent edition of |
5 | Diagnostic and Statistical Manual of Mental Disorders. |
6 | (2) "Health insurance policy" means any group health, |
7 | sickness or accident policy or subscriber contract or |
8 | certificate offered to groups of fifty-one (51) or more employes |
9 | issued by an entity subject to any one of the following: |
10 | (i) This act. |
11 | (ii) The act of December 29, 1972 (P.L.1701, No.364), known |
12 | as the "Health Maintenance Organization Act." |
13 | (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan |
14 | corporations) or 63 (relating to professional health services |
15 | plan corporations). |
16 | The term does not include accident only, fixed indemnity, |
17 | limited benefit, credit, dental, vision, specified disease, |
18 | Medicare supplement, Civilian Health and Medical Program of the |
19 | Uniformed Services (CHAMPUS) supplement, long-term care or |
20 | disability income, workers' compensation or automobile medical |
21 | payment insurance. |
22 | (3) "Insurer" means any entity offering a health insurance |
23 | policy as defined in this section. |
24 | Section 2. This act shall take effect in 60 days. |
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