PRINTER'S NO. 1925
No. 1624 Session of 1995
INTRODUCED BY L. I. COHEN, BELARDI, GEORGE, LEDERER, BEBKO-
JONES, CALTAGIRONE, HORSEY, CURRY, TRELLO, PISTELLA, TIGUE,
BISHOP, JOSEPHS, ITKIN, STABACK, BARD, E. Z. TAYLOR,
LAUGHLIN, YOUNGBLOOD, KUKOVICH, RICHARDSON AND STURLA,
MAY 10, 1995
REFERRED TO COMMITTEE ON INSURANCE, MAY 10, 1995
AN ACT
1 Requiring all health insurance policies to provide coverage for
2 complete treatment of congenital orofacial anomalies.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Short title.
6 This act shall be known and may be cited as the Insurance
7 Coverage for Congenital Orofacial Anomalies Act.
8 Section 2. Definitions.
9 The following words and phrases when used in this act shall
10 have the meanings given to them in this section unless the
11 context clearly indicates otherwise:
12 "Congenital orofacial anomaly." A defect from birth
13 affecting the mouth and jaw, including, but not limited to,
14 cleft palate and cleft lip and any condition or illness which is
15 related to or developed as a result of any such defect.
16 Section 3. Insurance coverage of congenital orofacial
1 anomalies.
2 Every insurance policy providing benefits for medical and
3 hospital expenses that is delivered, issued for delivery,
4 renewed, extended or modified in this Commonwealth by any health
5 care insurer shall provide coverage for the necessary care and
6 treatment of medically diagnosed congenital orofacial anomalies.
7 Necessary care and treatment shall include, but not be limited
8 to:
9 (1) Oral and facial surgery, surgical management and
10 follow-up care.
11 (2) Prosthetic treatment such as obdurators, speech
12 appliances and feeding appliances.
13 (3) Medically necessary orthodontic treatment.
14 (4) Medically necessary prosthodontic treatment.
15 (5) Habilitative speech language evaluation and therapy.
16 (6) Otolaryngology treatment.
17 (7) Audiological assessments and treatment, including
18 amplification devices.
19 (8) Psychological assessment and counseling.
20 (9) Genetic assessment and counseling for patient and
21 parents.
22 (10) Physical therapy assessment and treatment.
23 Section 4. Effective date.
24 This act shall take effect in 60 days.
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