PRINTER'S NO. 679
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
606
Session of
2015
INTRODUCED BY BURNS, KOTIK, KILLION, ROZZI, D. COSTA, BROWNLEE,
LONGIETTI, McNEILL, V. BROWN, PASHINSKI, DAVIDSON, KINSEY,
DeLUCA, KIRKLAND, COHEN, MAHONEY, MURT, MOUL, WATSON AND
SAINATO, FEBRUARY 24, 2015
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 24, 2015
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in health and accident insurance,
providing for oncology benefit design.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 631.1. Oncology Benefit Design.--(a) Individual or
group health insurance policies offered by an insurer providing
coverage for intravenously administered cancer chemotherapy that
also provide coverage for orally administered cancer
chemotherapy shall provide orally administered cancer
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chemotherapy with no less favorable patient cost-sharing than
for covered intravenously administered chemotherapy. This shall
include copayments, deductibles, coinsurance provisions and
maximum out-of-pocket limits that are based upon how the
chemotherapy is administered to the patient.
(b) This section shall apply to individual or group health
insurance policies offered by an insurer that may offer coverage
for orally administered or injected chemotherapy as part of a
prescription drug benefit. This shall include offerings made
directly through the insurer or an entity that insurer has
contracted with to provide, deliver, arrange for or reimburse
for coverage.
(c) Compliance with this section cannot be achieved by
imposing cost increases to patients for their out-of-pocket
costs for those patients currently receiving covered
chemotherapy agents regardless of the form of administration.
(d) This section shall apply to health insurance policies
offered, issued or renewed on or after July 1, 2015, in this
Commonwealth. This section shall not include the following
policies:
(1) Accident only.
(2) Fixed indemnity.
(3) Limited benefit.
(4) Credit.
(5) Dental.
(6) Vision.
(7) Medicare supplement.
(8) CHAMPUS (Civilian Health and Medical Program of the
Uniformed Services) supplement.
(9) Long-term care or disability income.
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(10) Long-term care.
(11) Workers' compensation.
(12) Automobile medical payment.
(e) The term "cancer chemotherapy" when used in this section
means medication that is prescribed by a physician for the
purpose of killing or slowing the growth of cancer cells.
(f) The term "insurer" when used in this section means a
company or health insurance entity licensed in this Commonwealth
to issue individual or group health, sickness or accident policy
or subscriber contract or certificate or plan that provides
medical or health care coverage by a health care facility or
licensed health care provider that is offered or governed under
this act or the following:
(1) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(2) The act of May 18, 1976 (P.L.123, No.54), known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
Section 2. This act shall take effect July 1, 2016.
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