PRINTER'S NO.  1513

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

SENATE BILL

 

No.

1138

Session of

2009

  

  

INTRODUCED BY LEACH, HUGHES, FERLO, WASHINGTON, TARTAGLIONE AND FARNESE, NOVEMBER 10, 2009

  

  

REFERRED TO BANKING AND INSURANCE, NOVEMBER 10, 2009  

  

  

  

AN ACT

  

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Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An

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act relating to insurance; amending, revising, and

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consolidating the law providing for the incorporation of

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insurance companies, and the regulation, supervision, and

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protection of home and foreign insurance companies, Lloyds

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associations, reciprocal and inter-insurance exchanges, and

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fire insurance rating bureaus, and the regulation and

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supervision of insurance carried by such companies,

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associations, and exchanges, including insurance carried by

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the State Workmen's Insurance Fund; providing penalties; and

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repealing existing laws," providing for coverage for eating

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disorder treatment.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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Section 1.  The act of May 17, 1921 (P.L.682, No.284), known

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as The Insurance Company Law of 1921, is amended by adding a

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section to read:

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Section 635.4.  Coverage for Eating Disorder Treatment.--(a)

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All health insurance policies as defined in this section shall

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provide coverage for treatment of eating disorders, including

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coverage for residential treatment of eating disorders, if such

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treatment is medically necessary in accordance with the practice

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guidelines for the treatment of patients with eating disorders,

 


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as most recently published by the American Psychiatric

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Association.

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(b)  A health insurance policy and an insurer shall not:

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(1)  deny to an individual eligibility, or continued

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eligibility, to enroll or to renew coverage under the terms of

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the health insurance policy, solely for the purpose of avioding

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the requirement of this section;

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(2)  provide monetary payments, rebates or other benefits to

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an individual to encourage the individual to accept less than

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the minimum protections available under this section;

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(3)  penalize or otherwise reduce or limit the reimbursement

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of a provider because the provider provided care to an

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individual participant or beneficiary in accordance with this

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section;

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(4)  provide incentives, monetary or otherwise, to a provider

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to induce the provider to provide care to an individual

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participant or beneficiary in a manner inconsistent with this

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section; or

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(5)  deny to an individual participant or beneficiary

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continued eligibility to enroll or to renew coverage under the

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terms of the policy solely because the individual was previously

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found to have an eating disorder or to have received treatment

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for an eating disorder.

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(c)  Nothing in this section may be construed as preventing a

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health insurance policy from imposing deductibles, coinsurance

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or other cost-sharing in relation to treatment for eating

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disorders, except that the deductibles, coinsurance or other

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cost-sharing shall not be greater than the deductibles,

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coinsurance or other cost-sharing imposed on other comparable

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medical or surgical services covered under the policy.

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(d)  For the purpose of this section:

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(1)  "Eating disorder" means anorexia nervosa, bulimia

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nervosa and eating disorders not otherwise specified, including

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binge eating disorder, as defined in the most recent edition of

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Diagnostic and Statistical Manual of Mental Disorders.

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(2)  "Health insurance policy" means any group health,

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sickness or accident policy or subscriber contract or

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certificate offered to groups of fifty-one (51) or more employes

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issued by an entity subject to any one of the following:

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(i)  This act.

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(ii)  The act of December 29, 1972 (P.L.1701, No.364), known

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as the "Health Maintenance Organization Act."

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(iii)  40 Pa.C.S. Ch. 61 (relating to hospital plan

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corporations) or 63 (relating to professional health services

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plan corporations).

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The term does not include accident only, fixed indemnity,

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limited benefit, credit, dental, vision, specified disease,

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Medicare supplement, Civilian Health and Medical Program of the

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Uniformed Services (CHAMPUS) supplement, long-term care or

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disability income, workers' compensation or automobile medical

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payment insurance.

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(3)  "Insurer" means any entity offering a health insurance

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policy as defined in this section.

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Section 2.  This act shall take effect in 60 days.

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