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," in health and accident insurance,
12providing for pregnancy as a preexisting condition and for
13coverage for maternity care; and, in health care insurance
14individual accessibility, further providing for policy choice
15for eligible individuals.

16The General Assembly of the Commonwealth of Pennsylvania
17hereby enacts as follows:

18Section 1.  The act of May 17, 1921 (P.L.682, No.284), known
19as The Insurance Company Law of 1921, is amended by adding
20sections to read:

21Section 635.7.  Pregnancy as a Preexisting Condition.--(a)
22All health insurance policies that are offered, issued or
23renewed on or after the effective date of this section may not
24impose any preexisting condition exclusion that relates to, or

1includes, a current or a prior pregnancy, complications
2regarding a current or prior pregnancy or the performance of a
3caesarean section for a prior pregnancy as a preexisting
4condition.

5(b)  This section shall not apply to the following types of
6policies:

7(1)  Accident only.

8(2)  Fixed indemnity.

9(3)  Limited benefit.

10(4)  Credit.

11(5)  Dental.

12(6)  Vision.

13(7)  Specified disease.

14(8)  Medicare supplement.

15(9)  Civilian Health and Medical Program of the Uniformed
16Services (CHAMPUS) supplement.

17(10)  Long-term care or disability income.

18(11)  Workers' compensation.

19(12)  Automobile medical payment.

20(c)  As used in this section:

21(1)  "Attending physician" means the attending obstetrician,
22pediatrician or other physician attending the mother of a
23newborn child.

24(2)  "Health care provider" means an attending physician,
25nurse practitioner or certified nurse midwife.

26(3)  "Health insurance policy" means any individual or group
27health or accident insurance policy or subscriber contract,
28certificate or plan offered to, issued to or renewed on or after
29the effective date of this section by an insurer which is
30offered by or subject to any of the following:

1(i)  This act.

2(ii)  The act of December 29, 1972 (P.L.1701, No.364), known
3as the "Health Maintenance Organization Act."

4(iii)  40 Pa.C.S. Ch. 61 (relating to hospital plan
5corporations) or 63 (relating to professional health services
6plan corporations).

7(iv)  Subarticle (f) of Article IV of the act of June 13,
81967 (P.L.31, No.21), known as the "Public Welfare Code."

9(v)  The act of May 18, 1976 (P.L.123, No.54), known as the
10"Individual Accident and Sickness Insurance Minimum Standards
11Act."

12(4)  "Insurer" means any entity that issues a health
13insurance policy, contract, certificate or plan described under
14clause (2) of this subsection.

15(5)  "Preexisting condition" means a condition or disease for
16which medical advice or treatment was recommended by or received
17from a health care provider prior to the effective date of the
18coverage.

19Section 635.8.  Coverage for Maternity Care.--(a)  All health
20insurance policies shall provide coverage for maternity care as
21follows:

22(1)  Prenatal care, which shall include coverage for regular
23health care visits and childbirth education in addition to
24ongoing assessment of nutritional and other individual needs
25consistent with nationally recognized standards and guidelines,
26such as those promulgated by the Institute for Clinical Systems
27Improvement (ICSI) or the American College of Obstetricians and
28Gynecologists (ACOG).

29(2)  Childbirth and postdelivery care as follows:

30(i)  Childbirth care shall include at a minimum coverage for

1delivery and postdelivery inpatient care for:

2(A)  Forty-eight (48) hours of inpatient care for a mother
3and her newborn child following a vaginal delivery.

4(B)  Ninety-six (96) hours of inpatient care for a mother and
5her newborn child following a caesarean section.

6(ii)  Any decision to shorten the minimum coverage provided
7shall be made by the health care provider in consultation with
8the mother. A health insurance policy shall not provide any
9compensation or other nonmedical remuneration to encourage a
10mother and her newborn child to leave inpatient care before the
11expiration of the minimum coverage specified in this section.

12(iii)  When discharge occurs prior to the times stated in
13this subsection, coverage shall include at least one home health
14care visit within forty-eight (48) hours after discharge by a
15health care provider whose scope of practice includes postpartum
16care.

17(iv)  Notwithstanding any other provision of this section, a
18policy that provides coverage for delivery and postdelivery care
19to a mother and her newborn child in the home shall not be
20required to provide for a minimum of forty-eight (48) hours and
21ninety-six (96) hours, respectively, of inpatient care unless
22the inpatient care is determined to be medically necessary by
23the health care provider consistent with nationally recognized
24treatment standards and guidelines such as those promulgated by
25ACOG or the American Academy of Pediatrics (AAP).

26(3)  Postpartum care, which shall be provided consistent with
27nationally recognized standards and guidelines, such as those
28promulgated by ACOG or AAP.

29(b)  Copayments, coinsurance and deductibles as follows:

30(1)  The coverage required under this section may be subject

1to any copayment, coinsurance or deductible amount in comparable
2amounts to those imposed for similar care.

3(2)  Notwithstanding clause (1), the health insurance policy
4shall not include any copayment, coinsurance or deductible
5amount for any postdelivery home health care visits required
6under subsection (a)(2).

7(c)  An insurer shall not refuse to contract with or
8compensate for covered services an otherwise eligible health
9care provider or nonparticipating health care provider solely
10because the health care provider has in good faith communicated
11with one or more of his current, former or prospective patients
12regarding the provisions, terms or requirements of the insurer's
13products as they relate to the needs of the health care
14provider's patients.

15(d)  This section shall not apply to the following types of
16policies:

17(1)  Accident only.

18(2)  Fixed indemnity.

19(3)  Limited benefit.

20(4)  Credit.

21(5)  Dental.

22(6)  Vision.

23(7)  Specified disease.

24(8)  Medicare supplement.

25(9)  Civilian Health and Medical Program of the Uniformed
26Services (CHAMPUS) supplement.

27(10)  Long-term care or disability income.

28(11)  Workers' compensation.

29(12)  Automobile medical payment.

30(e)  As used in this section:

1(1)  "Attending physician" means the attending obstetrician,
2pediatrician or other physician attending to a mother or her
3newborn child.

4(2)  "Birth center" means a licensed facility that is not
5part of a hospital that provides maternity care to mothers not
6requiring hospitalization.

7(3)  "Health care facility" means a hospital, birth center or
8health care provider's office.

9(4)  "Health care provider" means an attending physician,
10nurse practitioner or certified nurse midwife.

11(5)  "Health insurance policy" means any individual or group
12health or accident insurance policy or subscriber contract,
13certificate or plan offered to, issued to or renewed on or after
14the effective date of this section by an insurer that is offered
15by or is subject to any of the following:

16(i)  This act.

17(ii)  The act of December 29, 1972 (P.L.1701, No.364), known
18as the "Health Maintenance Organization Act."

19(iii)  40 Pa.C.S. Ch. 61 (relating to hospital plan
20corporations) or 63 (relating to professional health services
21plan corporations).

22(iv)  Subarticle (f) of Article IV of the act of June 13,
231967 (P.L.31, No.21), known as the "Public Welfare Code."

24(v)  The act of May 18, 1976 (P.L.123, No.54), known as the
25"Individual Accident and Sickness Insurance Minimum Standards
26Act."

27(6)  "Hospital" means a facility having an organized medical
28staff and providing equipment and services primarily for
29inpatient care to persons who require definitive diagnosis or
30treatment, or both, for injury, illness, pregnancy or other

1disability.

2(7)  "Insurer" means an entity that issues individual or
3group health insurance policy, contract or plan described under
4clause (5) of this subsection.

5(8)  "Maternity care" means prenatal care, childbirth and
6postdelivery care, and postpartum care provided at a health care
7facility or at the home of a mother.

8Section 2.  Section 1005-A(c) of the act, added November 4,
91997 (P.L.492, No.51), is amended and the section is amended by
10adding a subsection to read:

11Section 1005-A.  Policy Choice for Eligible Individuals.--

12* * *

13(c)  [Nothing] Except as otherwise provided in subsection 
14(d), nothing in this article shall prohibit an eligible
15individual from purchasing a policy which includes a preexisting
16condition provision or is not otherwise offered under this
17section from a designated insurer or any other insurer.

18(d)  (1)  Notwithstanding any other provision of law to the
19contrary, a policy offered, issued or renewed on or after the
20effective date of this subsection by a designated insurer or any
21other insurer shall not impose any preexisting condition
22exclusion that relates to, or includes, a current or a prior
23pregnancy, complications regarding a current or prior pregnancy
24or the performance of a caesarean section for a prior pregnancy.

25(2)  For the purposes of this subsection, "preexisting
26condition" shall have the meaning given in section 635.7.

27Section 3.  This act shall take effect in 60 days.