PRINTER'S NO. 232
THE GENERAL ASSEMBLY OF PENNSYLVANIA
INTRODUCED BY FARNESE, WASHINGTON, FONTANA, KASUNIC, SCHWANK, TARTAGLIONE, KITCHEN, TEPLITZ, BREWSTER, WILLIAMS, HUGHES, FERLO, SMITH, SOLOBAY, RAFFERTY, COSTA AND BOSCOLA, JANUARY 25, 2013
REFERRED TO BANKING AND INSURANCE, JANUARY 25, 2013
1Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2act relating to insurance; amending, revising, and
3consolidating the law providing for the incorporation of
4insurance companies, and the regulation, supervision, and
5protection of home and foreign insurance companies, Lloyds
6associations, reciprocal and inter-insurance exchanges, and
7fire insurance rating bureaus, and the regulation and
8supervision of insurance carried by such companies,
9associations, and exchanges, including insurance carried by
10the State Workmen's Insurance Fund; providing penalties; and
11repealing existing laws," in health and accident insurance,
12providing for pregnancy as a preexisting condition and for
13coverage for maternity care; and, in health care insurance
14individual accessibility, further providing for policy choice
15for eligible individuals.
1impose any preexisting condition exclusion that relates to, or
2includes, a current or a prior pregnancy, complications
3regarding a current or prior pregnancy or the performance of a
4caesarean section for a prior pregnancy as a preexisting
8(1) Accident only.
9(2) Fixed indemnity.
10(3) Limited benefit.
14(7) Specified disease.
15(8) Medicare supplement.
18(10) Long-term care or disability income.
19(11) Workers' compensation.
20(12) Automobile medical payment.
21(c) As used in this section:
27(3) "Health insurance policy" means any individual or group
28health or accident insurance policy or subscriber contract,
29certificate or plan offered to, issued to or renewed on or after
30the effective date of this section by an insurer which is
1offered by or subject to any of the following:
2(i) This act.
16(5) "Preexisting condition" means a condition or disease for
17which medical advice or treatment was recommended by or received
18from a health care provider prior to the effective date of the
23(1) Prenatal care, which shall include coverage for regular
24health care visits and childbirth education in addition to
25ongoing assessment of nutritional and other individual needs
26consistent with nationally recognized standards and guidelines,
27such as those promulgated by the Institute for Clinical Systems
28Improvement (ICSI) or the American College of Obstetricians and
30(2) Childbirth and postdelivery care as follows:
7(ii) Any decision to shorten the minimum coverage provided
8shall be made by the health care provider in consultation with
9the mother. A health insurance policy shall not provide any
10compensation or other nonmedical remuneration to encourage a
11mother and her newborn child to leave inpatient care before the
12expiration of the minimum coverage specified in this section.
13(iii) When discharge occurs prior to the times stated in
14this subsection, coverage shall include at least one home health
15care visit within forty-eight (48) hours after discharge by a
16health care provider whose scope of practice includes postpartum
18(iv) Notwithstanding any other provision of this section, a
19policy that provides coverage for delivery and postdelivery care
20to a mother and her newborn child in the home shall not be
21required to provide for a minimum of forty-eight (48) hours and
22ninety-six (96) hours, respectively, of inpatient care unless
23the inpatient care is determined to be medically necessary by
24the health care provider consistent with nationally recognized
25treatment standards and guidelines such as those promulgated by
26ACOG or the American Academy of Pediatrics (AAP).
30(b) Copayments, coinsurance and deductibles as follows:
4(2) Notwithstanding clause (1), the health insurance policy
5shall not include any copayment, coinsurance or deductible
6amount for any postdelivery home health care visits required
7under subsection (a)(2).
8(c) An insurer shall not refuse to contract with or
9compensate for covered services an otherwise eligible health
10care provider or nonparticipating health care provider solely
11because the health care provider has in good faith communicated
12with one or more of his current, former or prospective patients
13regarding the provisions, terms or requirements of the insurer's
14products as they relate to the needs of the health care
18(1) Accident only.
19(2) Fixed indemnity.
20(3) Limited benefit.
24(7) Specified disease.
25(8) Medicare supplement.
28(10) Long-term care or disability income.
29(11) Workers' compensation.
30(12) Automobile medical payment.
1(e) As used in this section:
12(5) "Health insurance policy" means any individual or group
13health or accident insurance policy or subscriber contract,
14certificate or plan offered to, issued to or renewed on or after
15the effective date of this section by an insurer that is offered
16by or is subject to any of the following:
17(i) This act.
14(c) [Nothing] Except as otherwise provided in subsection
15(d), nothing in this article shall prohibit an eligible
16individual from purchasing a policy which includes a preexisting
17condition provision or is not otherwise offered under this
18section from a designated insurer or any other insurer.
19(d) (1) Notwithstanding any other provision of law to the
20contrary, a policy offered, issued or renewed on or after the
21effective date of this subsection by a designated insurer or any
22other insurer shall not impose any preexisting condition
23exclusion that relates to, or includes, a current or a prior
24pregnancy, complications regarding a current or prior pregnancy
25or the performance of a caesarean section for a prior pregnancy.
28Section 3. This act shall take effect in 60 days.