PRIOR PRINTER'S NO. 2466

PRINTER'S NO.  3590

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

HOUSE BILL

 

No.

1865

Session of

2009

  

  

INTRODUCED BY BURNS, DeLUCA, BELFANTI, BISHOP, BOBACK, BRADFORD, BRIGGS, D. COSTA, DONATUCCI, FRANKEL, FREEMAN, GALLOWAY, GERBER, GOODMAN, GRUCELA, HALUSKA, HARHART, HENNESSEY, HESS, HORNAMAN, JOHNSON, JOSEPHS, KORTZ, KULA, MAHONEY, McGEEHAN, MURPHY, PALLONE, PHILLIPS, QUINN, READSHAW, REICHLEY, SABATINA, SANTONI, SIPTROTH, K. SMITH, SOLOBAY, R. TAYLOR, WALKO, YOUNGBLOOD, MENSCH, MURT, GIBBONS AND BOYLE, JULY 16, 2009

  

  

AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF REPRESENTATIVES, AS AMENDED, APRIL 21, 2010   

  

  

  

AN ACT

  

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Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An

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act relating to insurance; amending, revising, and

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consolidating the law providing for the incorporation of

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insurance companies, and the regulation, supervision, and

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protection of home and foreign insurance companies, Lloyds

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associations, reciprocal and inter-insurance exchanges, and

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fire insurance rating bureaus, and the regulation and

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supervision of insurance carried by such companies,

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associations, and exchanges, including insurance carried by

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the State Workmen's Insurance Fund; providing penalties; and

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repealing existing laws," providing for oncology benefit

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design.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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Section 1.  The act of May 17, 1921 (P.L.682, No.284), known

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as The Insurance Company Law of 1921, is amended by adding a

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section to read:

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Section 631.1.  Oncology Benefit Design.--(a)  All individual

<--

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or group health insurance policies offered by an insurer that

 


1

provides coverage for intravenously administered cancer

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chemotherapy that also provides coverage for orally administered

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cancer chemotherapy shall provide such coverage on equal terms

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to the insured. This shall include equalizing the copayments,

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deductibles, coinsurance provisions and maximum out-of-pocket

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limits without regard as to how the chemotherapy is

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administered.

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(b)  This section shall apply to all health insurance

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policies offered, issued or renewed on or after July 1, 2010, in

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this Commonwealth. This section shall not include the following

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policies:

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(1)  Accident only.

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(2)  Fixed indemnity.

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(3)  Limited benefit.

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(4)  Credit.

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(5)  Dental.

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(6)  Vision.

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(7)  Specified disease.

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(8)  Medicare supplement.

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(9)  CHAMPUS (Civilian Health and Medical Program of the

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Uniformed Services) supplement.

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(10)  Long-term care or disability income.

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(11)  Long-term care.

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(12)  Workers' compensation.

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(13)  Automobile medical payment.

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(c)  The term "cancer chemotherapy" when used in this section

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means medication that is prescribed by a physician for the

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purpose of killing or slowing the growth of cancer cells.

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(d)  The term "insurer" when used in this section means a

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company or health insurance entity licensed in this Commonwealth

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1

to issue any individual or group health, sickness or accident

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policy or subscriber contract or certificate or plan that

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provides medical or health care coverage by a health care

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facility or licensed health care provider that is offered or

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governed under this act or any of the following:

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(1)  The act of December 29, 1972 (P.L.1701, No.364), known

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as the "Health Maintenance Organization Act."

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(2)  The act of May 18, 1976 (P.L.123, No.54), known as the

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"Individual Accident and Sickness Insurance Minimum Standards

10

Act."

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(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan

12

corporations) or 63 (relating to professional health services

13

plan corporations).

14

Section 631.1.  Oncology Benefit Design.--(a)  Individual or

<--

15

group health insurance policies offered by an insurer providing

16

coverage for intravenously administered cancer chemotherapy that

17

also provide coverage for orally administered cancer

18

chemotherapy shall provide orally administered cancer

19

chemotherapy with no less favorable patient cost-sharing than

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for covered intravenously administered chemotherapy.

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This shall include copayments, deductibles, coinsurance

22

provisions and maximum out-of-pocket limits that are based upon

23

how the chemotherapy is administered to the patient.

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(b)  This section shall apply to individual or group health

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insurance policies offered by an insurer that may offer coverage

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for orally administered or injected chemotherapy as part of a

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prescription drug benefit. This shall include offerings made

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directly through the insurer or an entity that insurer has

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contracted with to provide, deliver, arrange for or reimburse

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for coverage.

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1

(c)  Compliance with this section cannot be achieved by

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imposing an increase in patient out-of-pocket costs for

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currently covered chemotherapy agents regardless of the form of

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administration.

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(d)  This section shall apply to health insurance policies

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offered, issued or renewed on or after July 1, 2011, in this

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Commonwealth. This section shall not include the following

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policies:

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(1)  Accident only.

10

(2)  Fixed indemnity.

11

(3)  Limited benefit.

12

(4)  Credit.

13

(5)  Dental.

14

(6)  Vision.

15

(7)  Medicare supplement.

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(8)  CHAMPUS (Civilian Health and Medical Program of the

17

Uniformed Services) supplement.

18

(9)  Long-term care or disability income.

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(10)  Long-term care.

20

(11)  Workers' compensation.

21

(12)  Automobile medical payment.

22

(e)  The term "cancer chemotherapy" when used in this section

23

means medication that is prescribed by a physician for the

24

purpose of killing or slowing the growth of cancer cells.

25

(f)  The term "insurer" when used in this section means a

26

company or health insurance entity licensed in this Commonwealth

27

to issue individual or group health, sickness or accident policy

28

or subscriber contract or certificate or plan that provides

29

medical or health care coverage by a health care facility or

30

licensed health care provider that is offered or governed under

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1

this act or the following:

2

(1)  The act of December 29, 1972 (P.L.1701, No.364), known

3

as the "Health Maintenance Organization Act."

4

(2)  The act of May 18, 1976 (P.L.123, No.54), known as the

5

"Individual Accident and Sickness Insurance Minimum Standards

6

Act."

7

(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan

8

corporations) or 63 (relating to professional health services

9

plan corporations).

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Section 2.  This act shall take effect in 60 days July 1,

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2011.

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