PRINTER'S NO. 454
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
469
Session of
2019
INTRODUCED BY DeLUCA, FRANKEL, A. DAVIS, HILL-EVANS, HARKINS,
KINSEY, SANCHEZ, NEILSON, SCHLOSSBERG, YOUNGBLOOD, D. MILLER,
CONKLIN, ISAACSON, DEASY, PASHINSKI, FREEMAN, KORTZ,
CALTAGIRONE, SCHWEYER, McNEILL, DONATUCCI, FITZGERALD,
KRUEGER, HARRIS, BRIGGS, ULLMAN, MULLINS, WARREN, BOYLE,
COMITTA, BULLOCK, MADDEN, RAVENSTAHL, BURGOS, KENYATTA,
READSHAW, KIRKLAND, MARKOSEK, T. DAVIS, SAMUELSON, DERMODY,
GOODMAN, McCLINTON, CIRESI AND SIMS, FEBRUARY 11, 2019
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 11, 2019
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 casualty insurance, providing
coverage for essential health benefits.
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 635.8. Coverage for Essential Health Benefits.--(a)
A health insurance policy offered, issued or renewed in this
Commonwealth shall include coverage for essential health
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benefits.
(b) Notwithstanding any other provision of law, the
provisions of this section providing greater protections to
individuals insured under a health insurance policy shall be
construed to supersede any law relating to a requirement of the
Patient Protection and Affordable Care Act (Public Law 111-148,
124 Stat. 119), except to the extent this section prevents the
application of a requirement of the Patient Protection and
Affordable Care Act.
(c) This act shall apply as follows:
(1) For health insurance policies for which either rates or
forms are required to be filed with the Insurance Department or
the Federal Government, this act shall apply to any policy for
which a form or rate is first filed on or after the effective
date of this section.
(2) For health insurance policies for which neither rates
nor forms are required to be filed with the Insurance Department
or the Federal Government, this act shall apply to any policy
issued or renewed on or after one hundred eighty days after the
effective date of this section.
(d) The Insurance Department may promulgate regulations
necessary for the implementation and administration of this
section.
(e) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Essential health benefits" means health care services and
benefits in the following categories:
(1) Ambulatory patient services.
(2) Emergency services.
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(3) Hospitalization.
(4) Maternity and newborn health care.
(5) Mental health and substance use disorder services,
including, but not limited to, behavioral health treatment.
(6) Prescription drugs.
(7) Rehabilitative and habilitative services and devices.
(8) Laboratory services.
(9) Preventive and wellness services and chronic disease
management.
(10) Pediatric services, including, but not limited to, oral
and vision care.
"Health insurance policy" means a policy, subscriber
contract, certificate or plan, issued by an insurer that
provides medical or health care coverage. The term does not
include any of the following policies:
(1) Accident only.
(2) Credit only.
(3) Long-term care or disability income.
(4) Specified disease.
(5) Medicare supplement.
(6) Tricare, including a Civilian Health and Medical Program
of the Uniformed Services (CHAMPUS) supplement.
(7) Fixed indemnity.
(8) Dental only.
(9) Vision only.
(10) Workers' compensation.
(11) Automobile medical payment under Pa.C.S. ยง 75 (relating
to vehicles).
"Health insurer" means an entity licensed by the Insurance
Department with accident and health authority to issue a policy,
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subscriber contract, certificate or plan that provides medical
or health care coverage that is offered or governed under any of
the following:
(1) This act, including, but not limited to, section 630 and
Article XXIV of this act.
(2) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization 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 in 30 days.
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