1Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An 
2act relating to insurance; amending, revising, and 
3consolidating the law providing for the incorporation of 
4insurance companies, and the regulation, supervision, and 
5protection of home and foreign insurance companies, Lloyds 
6associations, reciprocal and inter-insurance exchanges, and 
7fire insurance rating bureaus, and the regulation and 
8supervision of insurance carried by such companies, 
9associations, and exchanges, including insurance carried by 
10the State Workmen's Insurance Fund; providing penalties; and 
11repealing existing laws," providing for reimbursement for 
12prosthetic devices.

13The General Assembly finds and declares as follows:

14(1)  Individuals with limb loss face many challenges.
15Included in these challenges are the economic pressures
16placed on these individuals and their families.

17(2)  Individuals with limb loss need a prosthetic device
18to continue to function daily by maintaining educational
19activities or by being an integral part of the work force to
20provide for their own economic support and for their family.

21(3)  The intent of this act is to assist the special

1needs of individuals with limb loss to be functioning,
2contributing members of society.

3(4)  The General Assembly recognizes that a prosthetic
4device is critical to the well-being of individuals with limb
5loss and finds it necessary to require that health insurance
6policies issued in this Commonwealth include such coverage.

7The General Assembly of the Commonwealth of Pennsylvania
8hereby enacts as follows:

9Section 1.  The act of May 17, 1921 (P.L.682, No.284), known 
10as The Insurance Company Law of 1921, is amended by adding a 
11section to read:

12Section 635.7.  Reimbursement for Prosthetic Devices.--(a)  
13Except to the extent already covered under another policy, any 
14individual or group health, sickness and accident insurance 
15policy, group health insurance plans and policies, and all other 
16forms of managed and capitated care plans and policies or 
17subscriber contract or certificate issued by any entity subject 
18to 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 
1963 (relating to professional health services plan corporations) 
20or the act of December 29, 1972 (P.L.1701, No.364), known as the 
21"Health Maintenance Organization Act," or this act providing 
22hospital or medical and surgical coverage shall provide coverage 
23of prosthetic devices and components if prescribed by a health 
24care professional legally authorized to prescribe such items 
25under law. The benefits specified in this section may be 
26provided through a combination of policies, contracts, 
27certificates or riders, including major medical contracts.

28(b)  (1)  A health care insurer may require preauthorization
29to determine medical necessity and the eligibility of benefits
30for prosthetic devices and components.

1(2)  Coverage under this section shall also include the
2fitting, repair or replacement of a prosthetic device or
3component if the fitting, repair or replacement is determined to
4be medically necessary. A fitting, repair or replacement
5necessitated by the negligence of proper care and maintenance or
6by an abusive act committed by the individual having the
7prosthetic device shall not be covered.

8(3)  A health care insurer may require that prosthetic
9services be rendered by a provider that contracts with the
10carrier and that a prosthetic device or component be provided by
11a vendor designated by that insurer.

12(4)  Coverage shall not be required for a prosthetic device
13that is designed exclusively for athletic purposes.

14(5)  Coverage under this section shall remain subject to any
15copayment, coinsurance or deductible amounts imposed by an
16entity subject to this section for similar coverages under the
17same health insurance policy or contract.

18(6)  The attending physician must certify the medical
19necessity for a prosthetic device and component as a proposed
20course of treatment.

21(c)  When used in this section, the following terms shall
22have the meanings given to them in this subsection:

23(1)  "Component" means the materials and equipment needed to 
24ensure the comfort and functioning of a prosthetic device.

25(2)  "Limb" means an arm, a hand, a leg, a foot or any 
26portion of an arm, a hand, a leg or a foot.

27(3)  "Prosthetic device" means an artificial device to 
28replace a limb in whole or in part, including components.

29Section 2.  This act shall take effect in 60 days.