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PRINTER'S NO. 427
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
487
Session of
2015
INTRODUCED BY McILHINNEY, ARGALL, GORDNER, FONTANA, BREWSTER,
TARTAGLIONE, ALLOWAY, COSTA, RAFFERTY, BOSCOLA AND SMITH,
FEBRUARY 13, 2015
REFERRED TO BANKING AND INSURANCE, FEBRUARY 13, 2015
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," providing for limits on copayments
for insured medical services provided by a physical
therapist, chiropractor and occupational therapist.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding an
article to read:
ARTICLE X-B.
FAIRNESS IN MULTIPLE COPAYMENTS.
Section 1001-B. Declaration of intent.
The general purpose of this article is to provide fairness
for persons seeking appropriate physical therapy, chiropractic
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and occupational therapy who are sharing the cost of the care
pursuant to a health insurance policy by prohibiting the
imposition of multiple copayments for licensed physical therapy,
chiropractic and occupational therapy services.
Section 1002-B. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Chiropractic." As defined in section 102 of the act of
December 16, 1986 (P.L.1646, No.188), known as the Chiropractic
Practice Act.
"Copayment." A specific dollar amount a covered person must
pay for services rendered by a provider under a health benefit
plan.
"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
contract or plan that provides medical or health care
coverage by a health care facility or licensed health care
provider that is offered by or is governed under any of the
following:
(i) This act.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(iv) 40 Pa.C.S. Ch. 63 (relating to professional
health services plan corporations).
(2) The term does not include accident only, fixed
indemnity, limited benefit, credit, dental, vision, specified
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disease, Medicare supplement, Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) supplement, long-
term care or disability income, workers' compensation or
automobile medical payment insurance.
"Occupational therapy." As defined in section 3 of the act
of June 15, 1982 (P.L.502, No.140), known as the Occupational
Therapy Practice Act.
"Physical therapy." As defined in section 2 of the act of
October 10, 1975 (P.L.383, No.110), known as the Physical
Therapy Practice Act.
Section 1003-B. Limits on copayments.
A health insurance policy that is delivered, issued for
delivery, renewed, extended or modified in this Commonwealth by
a health care insurer for services provided by a licensed
physical therapist, chiropractor and occupational therapist
provider may not subject an insured to more than one copayment
amount per visit or deplete more than one visit.
Section 1004-B. Regulations.
The department may promulgate regulations as may be necessary
or appropriate to carry out the provisions of this article.
Section 1005-B. Penalties.
A violation of this article by an insurer if committed
flagrantly and in conscious disregard of the provisions of this
article or with frequency sufficient to constitute a general
business practice shall be considered a violation of the act of
July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance
Practices Act. A violation of this article is deemed an unfair
method of competition and an unfair deceptive act or practice
pursuant to the Unfair Insurance Practices Act.
Section 1006-B . Applicability.
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This article shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this article shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this section.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this article shall
apply to any policy issued or renewed on or after 180 days
after the effective date of this section.
Section 2. This act shall take effect in 60 days.
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