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," <-further providing for coverage for 
12mammographic examinations and for mastectomy and breast 
13cancer reconstruction; and providing for limits on copayments
14and coinsurances for insured medical services provided by a
15physical therapist, chiropractor or occupational therapist.

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 an
20article to read:

<-21Section 1. Section 632 of the act of May 17, 1921 (P.L.682,
22No.284), known as The Insurance Company Law of 1921, amended
23December 15, 1992 (P.L.1129, No.148), is amended to read:

24Section 632. Coverage for Mammographic Examinations and
 

1Mastectomies.--All group or individual health or sickness or
2accident insurance policies providing hospital or
3medical/surgical coverage and all group or individual subscriber
4contracts or certificates issued by any entity subject to 40
5Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63
6(relating to professional health services plan corporations),
7this act, the act of December 29, 1972 (P.L.1701, No.364), known
8as the "Health Maintenance Organization Act," the act of July
929, 1977 (P.L.105, No.38), known as the "Fraternal Benefit
10Society Code," or an employe welfare benefit plan as defined in
11section 3 of the Employee Retirement Income Security Act of 1974
12(Public Law 93-406, 29 U.S.C. § 1001 et seq.) providing hospital
13or medical/surgical coverage shall also provide coverage for
14mammographic examinations and the surgical procedure known as 
15mastectomy. The minimum coverage required shall include all
16costs associated with a mammogram every year for women 40 years
17of age or older and with any mammogram based on a physician's
18recommendation for women under 40 years of age. Prior to payment
19for a screening mammogram, insurers shall verify that the
20screening mammography service provider is properly licensed by
21the department in accordance with the act of July 9, 1992
22(P.L.449, No.93), known as the "Mammography Quality Assurance
23Act." [Nothing in this section shall be construed to require an
24insurer to cover the surgical procedure known as mastectomy or
25to prevent application of deductible or copayment provisions
26contained in the policy or plan.] An insurer shall be prohibited 
27from applying deductible or copayment provisions contained in a 
28policy or plan to mammographic examinations.

29Section 2. Section 633(a) of the act, added November 4, 1997
30(P.L.492, No.51), is amended to read:

1Section 633. Mastectomy and Breast Cancer Reconstruction.--
2(a) (1) No health insurance policy delivered, issued, executed
3or renewed in this Commonwealth on or after the effective date
4of this section shall require outpatient care following a
5mastectomy performed in a health care facility.

6(2) Policies described in clause (1) of this subsection
7shall provide coverage for inpatient care following a mastectomy
8for the length of stay that the treating physician determines is
9necessary to meet generally accepted criteria for safe
10discharge.

11(3) Such policies shall also provide coverage for a home
12health care visit that the treating physician determines is
13necessary within forty-eight hours after discharge when the
14discharge occurs within forty-eight hours following admission
15for the mastectomy.

16(4) Coverage under this section shall[, however, remain]
17not be subject to any copayment, coinsurance or deductible
18amounts set forth in the policy.

19* * *

20Section 3. The act is amended by adding an article to read:

21ARTICLE X-B.

22FAIRNESS IN MULTIPLE COPAYMENTS.

23Section 1001-B. Declaration of intent.

24The general purpose of this article is to provide fairness
25for persons seeking appropriate physical therapy, chiropractic
26and occupational therapy who are sharing the cost of the care
27pursuant to a health insurance policy by prohibiting the
28imposition of multiple copayments for licensed physical therapy,
29chiropractic and occupational therapy services.

30Section 1002-B. Definitions.

1The following words and phrases when used in this article
2shall have the meanings given to them in this section unless the
3context clearly indicates otherwise:

4"Chiropractic." As defined in section 102 of the act of
5December 16, 1986 (P.L.1646, No.188), known as the Chiropractic
6Practice Act.

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

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 that is offered by or is governed under any of the
15following:

16(i) This act.

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

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

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

24(2) The term does not include accident only, fixed
25indemnity, limited benefit, credit, dental, vision, specified
26disease, Medicare supplement, Civilian Health and Medical
27Program of the Uniformed Services (CHAMPUS) supplement, long-
28term care or disability income, workers' compensation or
29automobile medical payment insurance.

30"Occupational therapy." As defined in section 3 of the act

1of June 15, 1982 (P.L.502, No.140), known as the Occupational
2Therapy Practice Act.

3"Physical therapy." As defined in section 2 of the act of
4October 10, 1975 (P.L.383, No.110), known as the Physical
5Therapy Practice Act.

6Section 1003-B. Limits on copayments.

7A health insurance policy that is delivered, issued for
8delivery, renewed, extended or modified in this Commonwealth by
9a health care insurer for services provided by a licensed
10physical therapist, chiropractor or occupational therapist
11provider may not subject an insured to more than one copayment
12amount per visit or deplete more than one visit.

13Section 1004-B. Regulations.

14The department may promulgate regulations as may be necessary
15or appropriate to carry out the provisions of this article.

16Section 1005-B. Penalties.

17A violation of this article by an insurer if committed
18flagrantly and in conscious disregard of the provisions of this
19article or with frequency sufficient to constitute a general
20business practice shall be considered a violation of the act of 
21July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance 
22Practices Act. A violation of this article is deemed an unfair 
23method of competition and an unfair deceptive act or practice 
24pursuant to the Unfair Insurance Practices Act.

25Section 1006-B. Applicability.

26This article shall apply as follows:

27(1) For health insurance policies for which either rates
28or forms are required to be filed with the Insurance
29Department or the Federal Government, this article shall
30apply to any policy for which a form or rate is first filed

1on or after the effective date of this section.

2(2) For health insurance policies for which neither
3rates nor forms are required to be filed with the Insurance
4Department or the Federal Government, this article shall
5apply to any policy issued or renewed on or after 180 days
6after the effective date of this section.

7Section <-2 4. This act shall take effect in 60 days.