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 coverage for eating
12disorder treatment.

13The General Assembly of the Commonwealth of Pennsylvania
14hereby enacts as follows:

15Section 1. The act of May 17, 1921 (P.L.682, No.284), known
16as The Insurance Company Law of 1921, is amended by adding a
17section to read:

18Section 635.7. Coverage for Eating Disorder Treatment.--(a)
19All health insurance policies as defined in this section shall
20provide coverage for treatment of eating disorders, including
21coverage for residential treatment of eating disorders, if such
22treatment is medically necessary in accordance with the practice
23guidelines for the treatment of patients with eating disorders,

1as most recently published by the American Psychiatric
2Association.

3(b) A health insurance policy and an insurer shall not:

4(1) deny to an individual eligibility, or continued
5eligibility, to enroll or to renew coverage under the terms of
6the health insurance policy, solely for the purpose of avoiding
7the requirement of this section;

8(2) provide monetary payments, rebates or other benefits to
9an individual to encourage the individual to accept less than
10the minimum protections available under this section;

11(3) penalize or otherwise reduce or limit the reimbursement
12of a provider because the provider provided care to an
13individual participant or beneficiary in accordance with this
14section;

15(4) provide incentives, monetary or otherwise, to a provider
16to induce the provider to provide care to an individual
17participant or beneficiary in a manner inconsistent with this
18section; or

19(5) deny to an individual participant or beneficiary
20continued eligibility to enroll or to renew coverage under the
21terms of the policy solely because the individual was previously
22found to have an eating disorder or to have received treatment
23for an eating disorder.

24(c) Nothing in this section may be construed as preventing a
25health insurance policy from imposing deductibles, coinsurance
26or other cost-sharing in relation to treatment for eating
27disorders, except that the deductibles, coinsurance or other
28cost-sharing shall not be greater than the deductibles,
29coinsurance or other cost-sharing imposed on other comparable
30medical or surgical services covered under the policy.

1(d) For the purpose of this section:

2(1) "Eating disorder" means anorexia nervosa, bulimia
3nervosa and eating disorders not otherwise specified, including
4binge eating disorder, as defined in the most recent edition of
5Diagnostic and Statistical Manual of Mental Disorders.

6(2) "Health insurance policy" means any group health,
7sickness or accident policy or subscriber contract or
8certificate offered to groups of fifty-one (51) or more employes
9issued by an entity subject to any one of the following:

10(i) This act.

11(ii) The act of December 29, 1972 (P.L.1701, No.364), known
12as the "Health Maintenance Organization Act."

13(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
14corporations) or 63 (relating to professional health services
15plan corporations).

16The term does not include accident only, fixed indemnity,
17limited benefit, credit, dental, vision, specified disease,
18Medicare supplement, Civilian Health and Medical Program of the
19Uniformed Services (CHAMPUS) supplement, long-term care or
20disability income, workers' compensation or automobile medical
21payment insurance.

22(3) "Insurer" means any entity offering a health insurance
23policy as defined in this section.

24Section 2. This act shall take effect in 60 days.