PRINTER'S NO. 3526
No. 2538 Session of 2000
INTRODUCED BY GLADECK, BARRAR, BELARDI, BENNINGHOFF, BUNT,
CASORIO, CLARK, CLYMER, M. COHEN, CURRY, DAILEY, GEIST,
GEORGE, HENNESSEY, HORSEY, KENNEY, LAUGHLIN, R. MILLER,
MYERS, ORIE, RAMOS, READSHAW, ROBERTS, SEYFERT, SHANER,
STABACK, E. Z. TAYLOR, THOMAS, TRICH, VEON, WATERS, WILLIAMS,
WRIGHT, YOUNGBLOOD AND YUDICHAK, MAY 10, 2000
REFERRED TO COMMITTEE ON INSURANCE, MAY 10, 2000
AN ACT
1 Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2 act relating to insurance; amending, revising, and
3 consolidating the law providing for the incorporation of
4 insurance companies, and the regulation, supervision, and
5 protection of home and foreign insurance companies, Lloyds
6 associations, reciprocal and inter-insurance exchanges, and
7 fire insurance rating bureaus, and the regulation and
8 supervision of insurance carried by such companies,
9 associations, and exchanges, including insurance carried by
10 the State Workmen's Insurance Fund; providing penalties; and
11 repealing existing laws," providing for reimbursement for
12 brand name prescription drugs.
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. The act of May 17, 1921 (P.L.682, No.284), known
16 as The Insurance Company Law of 1921, is amended by adding a
17 section to read:
18 Section 635.2. Reimbursement for Brand Name Prescription
19 Drugs.--(a) As used in this section, the term "health insurance
20 policy" means any group health, sickness or accident policy or
21 subscriber contract or certificate and any other form of
1 managed/capitated care plan or policy, including a capitated
2 Medicare policy and a Medicare supplemental policy, which is
3 issued by an entity subject to one (1) of the following:
4 (1) This act.
5 (2) The act of December 29, 1972 (P.L.1701, No.364),
6 known as the "Health Maintenance Organization Act."
7 (3) The act of December 14, 1992 (P.L.835, No.134),
8 known as the "Fraternal Benefit Societies Code."
9 (4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
10 corporations) or 63 (relating to professional health services
11 plan corporations).
12 The term shall not include the following policies: accident
13 only, fixed indemnity, limited benefit, credit, dental, vision,
14 specified disease, CHAMPUS (Civilian Health and Medical Program
15 for the Uniformed Services) supplement, long-term care,
16 disability income, workers' compensation or automobile medical
17 payment.
18 (b) A health insurance policy which provides coverage for
19 prescription drugs shall provide coverage for brand name
20 prescription drugs when the prescribing physician determines
21 that it is medically necessary in order to sustain or improve
22 the health or condition of the patient.
23 (c) Coverage required under this section shall be subject to
24 annual deductibles and coinsurance requirements imposed by an
25 entity subject to this section for similar coverages under the
26 same health insurance policy.
27 Section 2. The addition of section 635.2 of the act shall
28 apply to any "health insurance policy," as defined in section
29 635.2(a) of the act, offered, issued or renewed on or after the
30 effective date of this act.
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1 Section 3. This act shall take effect in 90 days.
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