S0257B0237A06209 DMS:EJH 03/26/18 #90 A06209
AMENDMENTS TO SENATE BILL NO. 257
Sponsor: SENATOR WARD
Printer's No. 237
Amend Bill, page 2, line 5, by striking out "services" where
it occurs the first time
Amend Bill, page 2, line 5, by inserting after "services"
where it occurs the second time
and materials
Amend Bill, page 2, line 6, by striking out "an insured's"
and inserting
a health insurance
Amend Bill, page 2, lines 11 through 30; page 3, lines 1
through 3; by striking out all of said lines on said pages and
inserting
"Department." The Insurance Department of the Commonwealth.
"Insured." An individual on whose behalf a health insurer is
obligated to pay for vision care under a health insurance
policy.
Amend Bill, page 3, line 4, by striking out "Insurance" and
inserting
Health insurance
Amend Bill, page 3, line 5, by inserting after "policy,"
subscriber
Amend Bill, page 3, line 5, by inserting after "contract"
, certificate
Amend Bill, page 3, lines 5 through 8, by striking out ", a"
in line 5, all of lines 6 and 7 and "provider." in line 8 and
inserting
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that provides covered vision care. For purposes of this
article, the term includes vision only insurance coverage.
Amend Bill, page 3, lines 13 through 15, by striking out all
of said lines and inserting
"Health insurer." An entity licensed by the department with
an accident and health authority to issue a policy, subscriber
contract, certificate or plan that provides medical or health
care coverage, including vision coverage, and is offered or
governed under any of the following:
Amend Bill, page 3, line 16, by striking out "This act" and
inserting
Section 630, Article XXIV or other provision of this act
Amend Bill, page 3, lines 23 through 28, by striking out all
of said lines
Amend Bill, page 4, lines 5 and 6, by striking out "services,
materials or both by an eye care" in line 5 and all of line 6
and inserting
vision care.
"Noncovered services." Vision care that is not covered but
for which a discount may be provided under the terms of a health
insurance policy.
Amend Bill, page 4, lines 15 through 30; page 5, lines 1
through 30; page 6, lines 1 through 12; by striking out all of
said lines on said pages and inserting
"Vision care supplier." A person or entity, other than a
vision care provider, that creates, promotes, sells, provides,
advertises or administers vision care, including an optical
laboratory. The term includes persons or entities affiliated
with a health insurer.
Section 2703. Vision care provider and vision care supplier.
A health insurance policy shall allow an insured who receives
vision care from an in-network vision care provider to select an
out-of-network vision care supplier for related vision care on
the recommendation or referral of the in-network vision care
provider, provided that the in-network vision care provider
gives to the insured, prior to recommending, referring,
prescribing or ordering any vision care from the out-of-network
vision care supplier, written notice that:
(1) The out-of-network vision care supplier is not an
in-network vision care supplier.
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(2) The insured has the option of selecting an in-
network vision care supplier.
(3) The insured may have different financial obligations
depending on whether the vision care supplier is in-network
or out-of-network.
Section 2704. Discount access.
A health insurance policy providing discounts for noncovered
services provided by a vision care provider shall allow the
vision care provider to opt out of the contractual obligation to
provide such discounts, provided that the vision care provider
provides written disclosure to the insured that the vision care
provider does not participate in the insured's discount program.
Section 2705. Enforcement.
(a) Scope.--The department may investigate an enforce the
provisions of this article only insofar as the actions or
inactions being investigated relate to coverage under a health
insurance policy.
(b) Commissioner power.--Upon satisfactory evidence of a
violation of this article within the scope of the department's
investigative and enforcement authority under subsection (a),
the commissioner may, in the commissioner's discretion, impose
any of the penalties specified in section 5 of the act of June
25, 1997 (P.L.295, No.29), known as the Pennsylvania Health Care
Insurance Portability Act.
(c) Remedies cumulative.--The enforcement remedies imposed
under this section are in addition to any other remedies or
penalties that may be imposed under any other applicable law of
this Commonwealth, including the act of July 22, 1974 (P.L.589,
No.205), known as the Unfair Insurance Practices Act. A
violation of this article shall be deemed to be an unfair method
of competition and an unfair or deceptive act or practice under
the Unfair Insurance Practices Act.
(d) Administrative procedure.--The administrative provisions
of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies). A
party against whom penalties are assessed in an administrative
action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
Ch. 7 Subch. A (relating to judicial review of Commonwealth
agency action).
(e) Enforcement remedies.--The enforcement remedies imposed
under this section shall be in addition to any other remedies or
penalties that may be imposed under the laws of this
Commonwealth.
Section 2706. Regulations.
The department may promulgate regulations as may be necessary
or appropriate to implement this article.
Section 2707. Applicability.
This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with Federal Government or
the Insurance Department, this act shall apply to any policy
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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 Federal
Government or the Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this section.
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