1Limiting copayments and coinsurances for insured medical
2services.

3The General Assembly of the Commonwealth of Pennsylvania
4hereby enacts as follows:

5Section 1. Short title.

6This act shall be known and may be cited as the Fairness in
7Copayment Act.

8Section 2. Declaration of intent.

9The general purpose of this act shall be to provide fairness
10for persons seeking appropriate and necessary medical care who
11are sharing the cost of the care pursuant to a health insurance
12policy by limiting the imposition of copayments and coinsurances
13for nonphysician services to not more than the cost of the
14copayment or coinsurance for an insured's primary care physician
15office visit.

16Section 3. Definitions.

17The following words and phrases when used in this act shall

1have the meanings given to them in this section unless the
2context clearly indicates otherwise:

3"Coinsurance." A percentage of the contractual fee schedule
4of the provider that a covered person must pay for covered
5services and supplies rendered by the provider under a health
6insurance policy.

7"Copayment." The specified dollar amount a covered person
8must pay for covered services rendered by a provider under a
9health benefit plan.

10"Health insurance policy." As follows:

11(1) An individual or group health insurance policy,
12contract or plan that provides medical or health care
13coverage by a health care facility or licensed health care
14provider on an expense-incurred service or prepaid basis and
15that is offered by or is governed under any of the following:

16(i) Section 630 of the act of May 17, 1921 (P.L.682,
17No.284), known as The Insurance Company Law of 1921.

18(ii) The act of December 29, 1972 (P.L.1701,
19No.364), known as the Health Maintenance Organization
20Act.

21(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
22corporations).

23(iv) 40 Pa.C.S. Ch. 63 (relating to professional
24health services plan corporations).

25(v) 40 Pa.C.S. Ch. 67 (relating to beneficial
26societies).

27(2) The term does not include accident only, fixed
28indemnity, limited benefit, credit, dental, vision, specified
29disease, Medicare supplement, Civilian Health and Medical
30Program of the Uniformed Services (CHAMPUS) supplement, long-

1term care or disability income, workers' compensation or
2automobile medical payment insurance.

3"Physician." In connection with the application and use in
4this act, the term shall be as defined under section 2 of the
5act of December 20, 1985 (P.L.457, No.112), known as the Medical
6Practice Act of 1985.

7Section 4. Limits on copayments.

8A health insurance policy that is delivered, issued for
9delivery, renewed, extended or modified in this Commonwealth by
10a health care insurer may not impose a copayment or coinsurance
11that exceeds an insured's primary care physician office visit
12copayment or coinsurance amount. An insured may not be subjected
13to more than one copayment or coinsurance amount per visit for
14outpatient medical services provided by one provider or deplete
15more than one visit for outpatient medical services provided by
16one provider.

17Section 5. Applicability.

18This act shall apply to:

19(1) Insurance policies.

20(2) Subscriber contracts and group certificates issued
21under a group master policy delivered or issued for delivery
22on or after the effective date of this act.

23(3) Renewals of contracts on a renewal date that is on
24or after the effective date of this act.

25Section 6. Effective date.

26This act shall take effect in 60 days.