PRINTER'S NO. 1449
No. 1199 Session of 1977
INTRODUCED BY HANKINS, McKINNEY AND DUFFIELD, NOVEMBER 14, 1977
REFERRED TO INSURANCE, NOVEMBER 14, 1977
AN ACT
1 Amending the act of December 27, 1965 (P.L.1247, No.506),
2 entitled "An act relating to the reimbursement or payments
3 for providing and furnishing optometric services in
4 contracts, certificates and policies by various insurance and
5 other companies, and limiting the provisions in relation
6 thereto," further defining insurer and further providing for
7 reimbursement or payments.
8 The General Assembly of the Commonwealth of Pennsylvania
9 hereby enacts as follows:
10 Section 1. Sections 1 and 2, act of December 27, 1965
11 (P.L.1247, No.506), entitled "An act relating to the
12 reimbursement or payments for providing and furnishing
13 optometric services in contracts, certificates and policies by
14 various insurance and other companies, and limiting the
15 provisions in relation thereto," are amended to read:
16 Section 1. Definitions.--As used in this act:
17 [(1) "Insurer" shall mean (i) a nonprofit medical, dental
18 and osteopathic service corporation organized and operated under
19 the provisions of the "Nonprofit Corporation Law," approved May
20 5, 1933 (P.L.289), and its amendments, and the "Nonprofit
21 Medical, Dental and Osteopathic Service Corporation Act,"
1 approved June 27, 1939 (P.L.1125), as reenacted and amended
2 April 18, 1949 (P.L.587) and May 12, 1949 (P.L.1261), and its
3 amendments; (ii) a corporation or person incorporated under or
4 doing business in Pennsylvania by virtue of "The Insurance
5 Company Law of 1921," approved May 17, 1921 (P.L.682), and its
6 amendments; (iii) any person, company, corporation or society
7 authorized, created, doing business or existing under the
8 authority of or pursuant to the act of July 17, 1935 (P.L.1092),
9 entitled "An act defining fraternal benefit societies and their
10 status; authorizing such societies to create subordinate lodges
11 and to pay benefits to members and their beneficiaries from
12 funds collected, and regulating such benefits and collections;
13 providing for the organization and incorporation of such
14 societies and for their supervision, regulation and examination
15 by the Insurance Commissioner, and for the admission of foreign
16 societies; designating tables of mortality as a basis for rates
17 of contribution; requiring all societies to make annual and
18 other reports; and appointing the Insurance Commissioner as
19 attorney for service of process; providing penalties for any
20 violations of the act; exempting such societies from taxation
21 and certain other societies from its provisions; and requiring
22 beneficial associations, other than fraternal benefit societies,
23 to report to and be supervised by the Insurance Commissioner;
24 and repealing existing laws," and its amendments; (iv) any
25 person, company, corporation or society incorporated, doing
26 business or existing under, by virtue of, or pursuant to the act
27 of June 4, 1937 (P.L.1643), entitled "An act relating to certain
28 existing beneficial societies; conferring certain rights, powers
29 and duties upon them, their officers and members; authorizing
30 the payment of benefits by them in the event of sickness,
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1 accident, disability or death; regulating such societies and
2 corporations; and limiting the amount for which they may issue
3 membership certificates or policies; providing for reserves;
4 imposing penalties; and repealing certain existing laws and
5 parts of law," and its amendments; (v) any other persons,
6 associations, partnerships, common-law trusts, joint-stock
7 companies, nonprofit corporations, profit corporations or other
8 entity conducting an insurance business.
9 (2) "Optometrist" shall mean a person duly certified and
10 licensed to practice optometry under the act of March 30, 1917
11 (P.L.21), and its amendments.
12 (3) "Physician" shall mean a person duly certified to
13 practice medicine or osteopathy under the "Medical Practice Act"
14 and its amendments, or the "Osteopathic Act" and its
15 amendments.]
16 (1) "Insurer" shall mean (i) a corporation or person
17 incorporated under or doing business in Pennsylvania by virtue
18 of "The Insurance Company Law of 1921," approved May 17, 1921
19 (P.L.682, No.284), and its amendments; (ii) a corporation not-
20 for-profit subject to Title 40 Pa.C.S., Chapter 61 (relating to
21 hospital plan corporations), Chapter 63 (relating to
22 professional health services plan corporations), Chapter 65
23 (relating to fraternal benefit societies); (iii) a corporation
24 not-for-profit providing any health services by plans operating
25 under the act of December 29, 1972 (P.L.1701, No.364), known as
26 the "Voluntary Nonprofit Health Service Act of 1972;" (iv) any
27 person, company, corporation or society incorporated, doing
28 business or existing under, by virtue of, or pursuant to the act
29 of June 4, 1937 (P.L.1643, No.342), entitled "An act relating to
30 certain existing beneficial societies; conferring certain
19770S1199B1449 - 3 -
1 rights, powers and duties upon them, their officers and members;
2 authorizing the payment of benefits by them in the event of
3 sickness, accident, disability or death; regulating such
4 societies and corporations; and limiting the amount for which
5 they may issue membership certificates or policies; providing
6 for reserves; imposing penalties; and repealing certain existing
7 laws and parts of law;" (v) any other persons, associations,
8 partnerships, common-law trusts, joint-stock companies,
9 nonprofit corporations, profit corporations or other entity
10 conducting an insurance business.
11 (2) "Optometrist" shall mean a person duly licensed to
12 practice optometry under the act of March 30, 1917 (P.L.21,
13 No.10), referred to as the Optometry Practice Law.
14 (3) "Physician" shall mean any person duly licensed to
15 practice medicine or osteopathy under the act of July 20, 1974
16 (P.L.551, No.190), known as the "Medical Practice Act of 1974."
17 Section 2. [Whenever any insurer shall provide by contract,
18 policy, certificate or any other means whatsoever for a service
19 or for the partial or total reimbursement, payment or cost of a
20 service to or on behalf of any of its policyholders, group
21 policyholders, subscribers or group subscribers or any other
22 person or groups of persons, which service is within the lawful
23 scope of practice of a duly licensed optometrist, the person
24 rendering such service or such policyholder, subscriber or other
25 person shall be entitled to such partial or total reimbursement,
26 payment or cost for such service, whether the service is
27 performed by a duly licensed physician or by a duly licensed
28 optometrist. Unless such contract, policy, certificate or other
29 means employed shall otherwise provide, there shall be no
30 reimbursement or payment for ophthalmic materials, lenses,
19770S1199B1449 - 4 -
1 spectacles, eyeglasses and/or appurtenances thereto.] Whenever
2 any insurer shall provide under any policy of insurance for a
3 service or for the reimbursement of a service to or on behalf of
4 any of its policyholders, group policy holders, subscribers or
5 group subscribers or any other person or groups of persons,
6 which service is within the lawful scope of practice of a duly
7 licensed optometrist, the person rendering such service or such
8 policyholder, subscriber or other person shall be entitled to
9 the same reimbursement for such service whether the service is
10 performed by a duly licensed physician or by a duly licensed
11 optometrist. Unless such policy employed shall otherwise
12 provide, there shall be no reimbursement for ophthalmic
13 materials, lenses, spectacles, eyeglasses and/or appurtenances
14 thereto.
15 Section 2. The act is amended by adding a section to read:
16 Section 2.1. This act shall apply to all such policies,
17 contracts or certificates issued, renewed, modified, altered,
18 amended or reissued on or after the effective date of this act.
19 Section 3. This act shall take effect in 60 days.
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