PRINTER'S NO. 1268
No. 1118 Session of 1991
INTRODUCED BY RUDY, ITKIN, JOHNSON, KOSINSKI, CAWLEY, BELARDI,
DALEY, PESCI, KENNEY, PISTELLA, VEON, TELEK, E. Z. TAYLOR,
JAMES, STURLA, BELFANTI AND BISHOP, APRIL 10, 1991
REFERRED TO COMMITTEE ON INSURANCE, APRIL 10, 1991
AN ACT
1 Providing for reimbursement by insurance companies, professional
2 health service plan corporations, fraternal benefit societies
3 and voluntary nonprofit health service plans for service
4 performed by a licensed speech-language pathologist, a
5 licensed audiologist or a licensed teacher of the hearing
6 impaired; and providing for further duties of the Insurance
7 Department.
8 The General Assembly of the Commonwealth of Pennsylvania
9 hereby enacts as follows:
10 Section 1. Short title.
11 This act shall be known and may be cited as the Insurance
12 Payment to Licensed Speech-Language and Hearing Providers Law.
13 Section 2. Definitions.
14 The following words and phrases when used in this act shall
15 have the meanings given to them in this section unless the
16 context clearly indicates otherwise:
17 "Department." The Insurance Department of the Commonwealth.
18 Section 3. Policies and contracts covered.
19 (a) Coverage enumerated.--This act shall apply to every
20 group policy, contract or certificate of health, sickness or
1 accident insurance which is issued under this act and which is
2 delivered or issued for delivery within this Commonwealth,
3 including, but not limited to, policies, contracts or
4 certificates issued by:
5 (1) Any stock insurance company as described in section
6 202(a)(2) and (c)(2) and any mutual insurance company as
7 described in section 202(d)(1) of the act of May 17, 1921
8 (P.L.682, No.284), known as The Insurance Company Law of
9 1921.
10 (2) Any hospital plan corporation as defined in 40
11 Pa.C.S. Ch. 61 (relating to hospital plan corporations).
12 (3) Any professional health services plan corporation as
13 defined in 40 Pa.C.S. Ch. 63 (relating to professional health
14 services plan corporations).
15 (4) Any fraternal benefit society as defined in 40
16 Pa.C.S. Ch 65 (relating to fraternal benefit societies).
17 (5) Any voluntary nonprofit health service plan as
18 defined in the act of December 29, 1972 (P.L.1701, No.364),
19 known as the Health Maintenance Organization Act.
20 (6) Any person who sells or issues contracts or
21 certificates of insurance which meet the requirement of this
22 act.
23 (b) Application of act.--This act shall apply to policies,
24 contracts or certificates issued, renewed, modified, altered,
25 amended or reissued on and after the effective date of this act.
26 Section 4. Scope of coverage.
27 (a) General rule.--When a service is performed by a licensed
28 speech-language pathologist, a licensed audiologist or a
29 licensed teacher of the hearing impaired licensed by the State
30 Board of Examiners in Speech-Language and Hearing and lawfully
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1 permitted to perform that service under the act of December 21,
2 1984 (P.L.1253, No.238), known as the Speech-Language and
3 Hearing Licensure Act, and a policy, contract or certificate
4 provides for reimbursement for that service, the insured or any
5 other person covered shall be entitled to reimbursement either
6 to the insured or to the licensed speech-language pathologist,
7 licensed audiologist, or licensed teacher of the hearing
8 impaired providing that service.
9 (b) Application of reimbursement process.--Nothing in this
10 section shall apply to the assignment of benefits and payment of
11 claims process of a stock insurance company and a mutual
12 insurance company as set forth in section 3(a)(1).
13 (c) Nonduplication of payments.--Duplicate payment shall not
14 be made:
15 (1) to both a speech-language or hearing provider as set
16 forth in subsection (a) and to another provider; or
17 (2) to the same provider for the same services provided
18 in a single encounter.
19 Section 5. Rules and regulations.
20 The department shall, in the manner provided by law,
21 promulgate rules, regulations and forms necessary to carry out
22 this act.
23 Section 6. Effective date.
24 This act shall take effect in 120 days.
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