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.

16The General Assembly of the Commonwealth of Pennsylvania
17hereby enacts as follows:

18Section 1. The act of May 17, 1921 (P.L.682, No.284), known
19as The Insurance Company Law of 1921, is amended by adding
20sections to read:

21Section 635.7. Pregnancy as a Preexisting Condition.--(a)
22All health insurance policies that are offered, issued or
23renewed on or after the effective date of this section may not

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
5condition.

6(b) This section shall not apply to the following types of
7policies:

8(1) Accident only.

9(2) Fixed indemnity.

10(3) Limited benefit.

11(4) Credit.

12(5) Dental.

13(6) Vision.

14(7) Specified disease.

15(8) Medicare supplement.

16(9) Civilian Health and Medical Program of the Uniformed
17Services (CHAMPUS) 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:

22(1) "Attending physician" means the attending obstetrician,
23pediatrician or other physician attending the mother of a
24newborn child.

25(2) "Health care provider" means an attending physician,
26nurse practitioner or certified nurse midwife.

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.

3(ii) Subarticle (f) of Article IV of the act of June 13,
41967 (P.L.31, No.21), known as the "Public Welfare Code."

5(iii) The act of December 29, 1972 (P.L.1701, No.364), known
6as the "Health Maintenance Organization Act."

7(iv) The act of May 18, 1976 (P.L.123, No.54), known as the
8"Individual Accident and Sickness Insurance Minimum Standards
9Act."

10(v) 40 Pa.C.S. Ch. 61 (relating to hospital plan
11corporations) or 63 (relating to professional health services
12plan corporations).

13(4) "Insurer" means any entity that issues a health
14insurance policy, contract, certificate or plan described under
15clause (2) of this subsection.

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
19coverage.

20Section 635.8. Coverage for Maternity Care.--(a) All health
21insurance policies shall provide coverage for maternity care as
22follows:

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
29Gynecologists (ACOG).

30(2) Childbirth and postdelivery care as follows:

1(i) Childbirth care shall include at a minimum coverage for
2delivery and postdelivery inpatient care for:

3(A) Forty-eight (48) hours of inpatient care for a mother
4and her newborn child following a vaginal delivery.

5(B) Ninety-six (96) hours of inpatient care for a mother and
6her newborn child following a caesarean section.

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
17care.

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).

27(3) Postpartum care, which shall be provided consistent with
28nationally recognized standards and guidelines, such as those
29promulgated by ACOG or AAP.

30(b) Copayments, coinsurance and deductibles as follows:

1(1) The coverage required under this section may be subject
2to any copayment, coinsurance or deductible amount in comparable
3amounts to those imposed for similar care.

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
15provider's patients.

16(d) This section shall not apply to the following types of
17policies:

18(1) Accident only.

19(2) Fixed indemnity.

20(3) Limited benefit.

21(4) Credit.

22(5) Dental.

23(6) Vision.

24(7) Specified disease.

25(8) Medicare supplement.

26(9) Civilian Health and Medical Program of the Uniformed
27Services (CHAMPUS) 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:

2(1) "Attending physician" means the attending obstetrician,
3pediatrician or other physician attending to a mother or her
4newborn child.

5(2) "Birth center" means a licensed facility that is not
6part of a hospital that provides maternity care to mothers not
7requiring hospitalization.

8(3) "Health care facility" means a hospital, birth center or
9health care provider's office.

10(4) "Health care provider" means an attending physician,
11nurse practitioner or certified nurse midwife.

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.

18(iii) The act of December 29, 1972 (P.L.1701, No.364), known
19as the "Health Maintenance Organization Act."

20(ii) Subarticle (f) of Article IV of the act of June 13,
211967 (P.L.31, No.21), known as the "Public Welfare Code."

22(iv) The act of May 18, 1976 (P.L.123, No.54), known as the
23"Individual Accident and Sickness Insurance Minimum Standards
24Act."

25(v) 40 Pa.C.S. Ch. 61 (relating to hospital plan
26corporations) or 63 (relating to professional health services
27plan corporations).

28(6) "Hospital" means a facility having an organized medical
29staff and providing equipment and services primarily for
30inpatient care to persons who require definitive diagnosis or

1treatment, or both, for injury, illness, pregnancy or other
2disability.

3(7) "Insurer" means an entity that issues individual or
4group health insurance policy, contract or plan described under
5clause (5) of this subsection.

6(8) "Maternity care" means prenatal care, childbirth and
7postdelivery care, and postpartum care provided at a health care
8facility or at the home of a mother.

9Section 2. Section 1005-A(c) of the act, added November 4,
101997 (P.L.492, No.51), is amended and the section is amended by
11adding a subsection to read:

12Section 1005-A. Policy Choice for Eligible Individuals.--* *
13*

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.

26(2) For the purposes of this subsection, "preexisting
27condition" shall have the meaning given in section 635.7.

28Section 3. This act shall take effect in 60 days.