PRIOR PRINTER'S NOS. 1867, 3892
PRINTER'S NO. 4244
THE GENERAL ASSEMBLY OF PENNSYLVANIA
INTRODUCED BY TRUITT, PAINTER, YOUNGBLOOD, BARRAR, BISHOP, MILLARD, ROZZI, SCHLOSSBERG, V. BROWN, BROOKS, SABATINA, HEFFLEY, WATSON, MURT, GINGRICH, BRADFORD, D. MILLER, BROWNLEE AND TOOHIL, MAY 23, 2013
SENATOR WHITE, BANKING AND INSURANCE, IN SENATE, AS AMENDED, OCTOBER 6, 2014
1Amending the act of December 20, 1996 (P.L.1492, No.191),
2entitled "An act providing for certain health insurance
3policies to cover the cost of formulas necessary for the
4treatment of phenylketonuria and related disorders," amending
5the title of the act; and further providing for medical foods
6insurance coverage and, for cost-sharing provisions, for<-
7regulations and for applicability<-.
1phenylketonuria and [related] other disorders.
2Section 4. Medical foods insurance coverage.
3(a) Nutritional supplements.--Except as provided in section
47, any health insurance policy which is delivered, issued for
5delivery, renewed, extended or modified in this Commonwealth by
6any health care insurer shall provide that the health insurance
7benefits applicable under the policy include coverage for the
8cost of nutritional supplements (formulas) as medically
9necessary for the therapeutic treatment of phenylketonuria,
10branched-chain ketonuria, galactosemia and homocystinuria as
11administered under the direction of a physician.
12(b) Amino acid-based elemental medical formula.--Except as
13provided in section 7, any health insurance policy which is
14delivered, issued for delivery, renewed, extended or modified in
15this Commonwealth by any health care insurer shall provide that
16the health insurance benefits applicable under the policy
17include coverage for infants and children for the <-usual and
18customary cost of amino acid-based elemental medical formula
<-19prescribed ordered by a physician <-as medically necessary and
20administered orally or enterally for IgE and non-IgE <-mediated
21food protein allergies, food protein-induced enterocolitis
22syndrome, eosinophilic disorders and short-bowel syndrome. <-An
23amino acid-based elemental formula covered under this section is
24a formula made of 100% free amino acids as the protein source.
25Section 6. Cost-sharing provisions.
26(a) Applicability.--Benefits for nutritional supplements
27(formulas) as medically necessary for the therapeutic treatment
28of phenylketonuria, branched-chain ketonuria, galactosemia and
29homocystinuria as administered under the direction of a
30physician shall be subject to copayment and coinsurance
4(a.1) Amino acid-based elemental medical formula.--Benefits
5for amino acid-based elemental medical formula <-prescribed
<-6ordered by a physician as medically necessary for <-IgE and non-
7IgE mediated food protein allergies, food protein-induced
8enterocolitis syndrome, eosinophilic disorders and short-bowel
9syndrome shall be subject to copayment and coinsurance
10provisions of a health insurance policy to the extent that other
11medical services covered by the policy are subject to those
13(b) Exemption.--Benefits for nutritional supplements
14(formulas) as medically necessary for the therapeutic treatment
15of phenylketonuria, branched-chain ketonuria, galactosemia and
16homocystinuria as administered under the direction of a
17physician shall be exempt from deductible provisions in a health
18insurance policy. This exemption must be explicitly provided for
19in the policy.
<-20Section 8. Regulations.
24Section 9. Applicability.
25[This act shall apply to all insurance policies, subscriber
26contracts and group insurance certificates issued under any
27group master policy delivered or issued for delivery on or after
28the effective date of this act. This act shall also apply to all
29renewals of contracts on any renewal date which is on or after
30the effective date of this act.] This act shall apply as
2(1) For health insurance policies for which either rates
3or forms are required to be filed with the Insurance
4Department or the Federal Government, this act shall apply to
5any policy for which a form or rate is first filed on or
6after the effective date of this section.
7(2) For health insurance policies for which neither
8rates nor forms are required to be filed with the Insurance
9Department or the Federal Government, this act shall apply to
10any policy issued or renewed on or after 180 days after the
11effective date of this section.
12Section 2. This act shall take effect in 180 days.