PRINTER'S NO. 3820
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2322
Session of
2015
INTRODUCED BY KAUFER, DRISCOLL, HARHART, BOBACK, TOOHIL, TAYLOR,
RADER, COOK-ARTIS, RAPP, DAVIS, NELSON, MURT, BAKER, GINGRICH
AND KAUFFMAN, SEPTEMBER 9, 2016
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 9, 2016
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for disclosure of addiction treatment
coverage and for administrative penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 37
DISCLOSURE OF ADDICTION TREATMENT COVERAGE
Sec.
3701. Purpose.
3702. Definitions.
3703. Emergency addendum.
3704. Administrative penalties.
3705. Applicability.
§ 3701. Purpose.
The purpose of this chapter is to require the complete and
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proper disclosure and transparency of addiction services covered
by policies issued to policy holders.
§ 3702. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Department." The Insurance Department of the Commonwealth.
" Insurer. " An entity that issues or administers health
insurance policies or health plans and is subject to the
jurisdiction of the department. The term includes an entity
organized or existing under, or subject to, any of the
following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) Chapter 61 (relating to hospital plan corporations)
or 63 (relating to professional health services plan
corporations).
§ 3703. Emergency addendum.
(a) Explanation of coverage.--The department shall direct
each insurer to provide its members and insureds with an
emergency addendum explaining the coverage for addiction
treatment services covered under the policy or plan.
(b) Requirement for emergency addendum.--An emergency
addendum issued under this chapter shall be no more than two
pages and contain language that is nontechnical and readily
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understandable and that explains how to access covered services
and the process to file an appeal.
(c) Review of emergency addendum.--Before an insurer
provides an emergency addendum under this chapter, the insurer
shall submit the emergency addendum to the department and the
Department of Drug and Alcohol Programs for review for clarity
and accuracy.
(d) Approval of emergency addendum.--An emergency addendum
may not be issued until the department and the Department of
Drug and Alcohol Programs approve the emergency addendum.
§ 3704. Administrative penalties.
The failure of an insurer to comply with section 3703
(relating to emergency addendum) shall result in a fine or other
penalty as the department determines.
§ 3705. Applicability.
Section 303 of the act of December 18, 1996 (P.L.1066,
No.159), known as the Accident and Health Filing Reform Act,
shall not apply to an emergency addendum under this chapter.
Section 2. This act shall take effect immediately.
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