H0746B2004A01489     BIL:JSL  06/05/09     #90        A01489

AMENDMENTS TO HOUSE BILL NO. 746

Sponsor: REPRESENTATIVE KILLION

Printer's No. 2004

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Amend Bill, page 1, line 29, by inserting a comma after

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"parents"

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Amend Bill, page 1, line 30, by striking out "and" and

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inserting a comma

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Amend Bill, page 1, line 31, by inserting after "coverage"

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 and for BasicCare health insurance

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Amend Bill, page 23, lines 25 and 26, by striking out "an" in

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line 25 and "article" in line 26 and inserting

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 articles

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Amend Bill, page 42, by inserting between lines 29 and 30

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ARTICLE XLIII

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BASICCARE HEALTH INSURANCE

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Section 4301.  Scope of article.

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This article relates to BasicCare health insurance.

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Section 4302.  Definitions.

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The following words and phrases when used in this article

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shall have the meanings given to them in this section unless the

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context clearly indicates otherwise:

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"BasicCare policy."  A health benefit plan that provides

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health or sickness and accident coverage as specified in the

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Special Care, Guaranteed Renewable, Hospital Benefit Contract

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for Direct Payment Subscribers, Form 4044 on file with the

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department as of April 2, 2009, to an individual or small

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employer group with coverage for dependents offered as an

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additional option.

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"Department."  The Insurance Department of the Commonwealth.

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"Health benefit plan."  An individual or group health

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insurance policy, subscriber contract, certificate or plan,

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which provides medical or health care coverage by a health care

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facility or licensed health care provider and which is offered

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by an insurer. The term does not include any of the following:

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(1)  An accident-only policy.

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(2)  A limited benefit policy.

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(3)  A credit-only policy.

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(4)  A long-term care or disability income policy.

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(5)  A specified disease policy.

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(6)  A Medicare supplement policy.

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(7)  A Civilian Health and Medical Program of the

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Uniformed Services (CHAMPUS) supplement policy.

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(8)  An automobile medical payment policy under 75

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Pa.C.S. (relating to vehicles).

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(9)  A vision-only policy.

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(10)  A workers' compensation policy.

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(11)  A dental policy.

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(12)  A fixed indemnity policy.

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"Insurer."  A company or insurance entity licensed in this

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Commonwealth to issue an individual or group insurance policy,

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subscriber contract, certificate or plan which is offered or

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governed under any of the following:

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(1)  This act.

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(2)  The act of December 29, 1972 (P.L.1701, No.364),

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known as the Health Maintenance Organization Act.

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(3)  The act of May 18, 1976 (P.L.123, No.54), known as

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the Individual Accident and Sickness Insurance Minimum

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Standards Act.

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(4)  40 Pa.C.S. Ch. 61 (relating to hospital plan

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corporations) or Ch. 63 (relating to professional health

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services plan corporations).

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"Small employer group."  A group of at least two but not more

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than 50 individuals employed by the same person.

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Section 4303.  BasicCare policy.

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(a)  Requirement.--Within 90 days of the effective date of

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this section, an insurer issuing or delivering a health benefit

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plan in this Commonwealth shall make available for purchase by

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individuals and small employer groups a BasicCare policy.

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(b)  Coverage.--Coverage under a BasicCare policy shall be

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subject to any copayment permitted under the Special Care,

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Guaranteed Renewable, Hospital Benefit Contract for Direct

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Payment Subscribers, Form 4044 on file with the department as of

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April 2, 2009.

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(c)  Cost sharing.--Coverage under a BasicCare policy may be

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subject to coinsurance or deductible.

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(d)  Exclusion.--An insurer may exclude coverage under a

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BasicCare policy for an individual who has not been covered by a

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health benefit plan for more than 30 days, for up to one year

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for medical conditions for which medical advice or treatment was

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received by the individual during the 12 months prior to the

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effective date of the individual’s BasicCare policy.

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(e)  Applicability.--No law, regulation or administrative

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directive requiring the coverage of a health care benefit or

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service or requiring the reimbursement, utilization or inclusion

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of a specific category of licensee shall apply to a BasicCare

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policy delivered or issued for delivery in this Commonwealth

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under the authority granted under this article, including the

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provision of the benefits or requirements mandated under Article

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VI-A, or regulations promulgated under this act.

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Section 4304.  Department duties.

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The department shall take all actions necessary to ensure

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that insurers make available for purchase BasicCare policies no

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later than 90 days following the effective date of this section.