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," providing for limits on copayments
12and coinsurances for insured medical services provided by a
13physical therapist, chiropractor or occupational therapist.

14The General Assembly of the Commonwealth of Pennsylvania
15hereby enacts as follows:

16Section 1. The act of May 17, 1921 (P.L.682, No.284), known
17as The Insurance Company Law of 1921, is amended by adding an
18article to read:

19ARTICLE X-B.

20FAIRNESS IN MULTIPLE COPAYMENTS.

21Section 1001-B. Declaration of intent.

22The general purpose of this article is to provide fairness
23for persons seeking appropriate physical therapy, chiropractic
24and occupational therapy who are sharing the cost of the care

1pursuant to a health insurance policy by prohibiting the
2imposition of multiple copayments <-and coinsurance for licensed
3physical therapy, chiropractic and occupational therapy
4services.

5Section 1002-B. Definitions.

6The following words and phrases when used in this article
7shall have the meanings given to them in this section unless the
8context clearly indicates otherwise:

9"Chiropractic." As defined in section 102 of the act of
10December 16, 1986 (P.L.1646, No.188), known as the Chiropractic
11Practice Act.

<-12"Coinsurance." A percentage of the contractual fee schedule
13of the provider that a covered person must pay for covered
14services and supplies rendered by the provider under a health
15insurance policy.

16"Copayment." A specific dollar amount a covered person must
17pay for services rendered by a provider under a health benefit
18plan.

19"Health insurance policy." As follows:

20(1) An individual or group health insurance policy,
21contract or plan that provides medical or health care
22coverage by a health care facility or licensed health care
23provider that is offered by or is governed under any of the
24following:

25(i) This act.

26(ii) The act of December 29, 1972 (P.L.1701,
27No.364), known as the Health Maintenance Organization
28Act.

29(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
30corporations).

1(iv) 40 Pa.C.S. Ch. 63 (relating to professional
2health services plan corporations).

3(2) The term does not include accident only, fixed
4indemnity, limited benefit, credit, dental, vision, specified
5disease, Medicare supplement, Civilian Health and Medical
6Program of the Uniformed Services (CHAMPUS) supplement, long-
7term care or disability income, workers' compensation or
8automobile medical payment insurance.

9"Occupational therapy." As defined in section 3 of the act
10of June 15, 1982 (P.L.502, No.140), known as the Occupational
11Therapy Practice Act.

12"Physical therapy." As defined in section 2 of the act of
13October 10, 1975 (P.L.383, No.110), known as the Physical
14Therapy Practice Act.

15Section 1003-B. Limits on copayments.

16A health insurance policy that is delivered, issued for
17delivery, renewed, extended or modified in this Commonwealth by
18a health care insurer <-may not subject an insured to more than
19one copayment or coinsurance amount per visit or deplete more
20than one visit for services provided by a licensed physical
21therapist, chiropractor or occupational therapist provider on a
22given date. <-for services provided by a licensed physical
23therapist, chiropractor or occupational therapist provider may
24not subject an insured to more than one copayment amount per
25visit or deplete more than one visit.

26Section 1004-B. Regulations.

27The department may promulgate regulations as may be necessary
28or appropriate to carry out the provisions of this article.

29Section 1005-B. Penalties.

30A violation of this article by an insurer if committed

1flagrantly and in conscious disregard of the provisions of this
2article or with frequency sufficient to constitute a general
3business practice shall be considered a violation of the act of 
4July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance 
5Practices Act. A violation of this article is deemed an unfair 
6method of competition and an unfair deceptive act or practice 
7pursuant to the Unfair Insurance Practices Act.

8Section <-1004-B 1006-B. Applicability.

9This article shall apply as follows:

10(1) For health insurance policies for which either rates
11or forms are required to be filed with the Insurance
12Department or the Federal Government, this article shall
13apply to any policy for which a form or rate is first filed
14on or after the effective date of this section.

15(2) For health insurance policies for which neither
16rates nor forms are required to be filed with the Insurance
17Department or the Federal Government, this article shall
18apply to any policy issued or renewed on or after 180 days
19after the effective date of this section.

20Section 2. This act shall take effect in 60 days.