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PRINTER'S NO. 124
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
130
Session of
2019
INTRODUCED BY D. MILLER, A. DAVIS, ISAACSON, SCHLOSSBERG,
SOLOMON, STURLA, YOUNGBLOOD, CIRESI, NEILSON, DeLUCA, OTTEN,
SIMS, HILL-EVANS, KORTZ, CALTAGIRONE AND McCLINTON,
JANUARY 28, 2019
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 28, 2019
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," in casualty insurance, providing
for billing eligible insureds for services by out-of-network
provider.
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 a
section to read:
Section 617.2. Billing Eligible Insureds for Services by
Out-of-Network Provider.--(A) An out-of-network provider that
renders mental health care, substance use disorder treatment or
treatment for a disability to an eligible insured in this
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Commonwealth is prohibited from billing an eligible insured for
any amount in excess of the cost-sharing amounts that would have
been imposed if the mental health care, substance use disorder
treatment or treatment for a disability had been rendered by an
in-network provider.
(B) The Insurance Commissioner may promulgate rules and
regulations necessary to implement and administer this section.
(C) For the purposes of this section:
"Cost-sharing" means a copayment, coinsurance, deductible or
similar charge. The term does not include premiums or the cost
of noncovered services.
"Disability" means:
(1) A physical or mental impairment which substantially
limits one or more of a person's major life activities.
(2) A record of having an impairment under paragraph (1).
(3) Being regarded as having an impairment under paragraph
(1).
(4) The term does not include the current, illegal use of or
addiction to a controlled substance, as defined in section 102
of the Controlled Substances Act (Public Law 91-513, 84 Stat.
1236).
"Eligible insured" means an individual twenty-one years of
age or younger who is insured under a health insurance policy.
"Health care provider" means a person, corporation, facility,
institution or other entity licensed, certified or approved by
the Commonwealth to provide health care or professional medical
services. The term includes, but is not limited to, a physician,
a professional nurse, a certified nurse-midwife, a podiatrist, a
hospital, an ambulatory surgical center or a birth center.
"Health insurance policy" means an individual or group
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health, sickness or accident policy, or subscriber contract or
certificate offered, issued or renewed by an entity subject to
one of the following:
(1) This act.
(2) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(4) The term does not include accident only, fixed
indemnity, limited benefit, credit, dental, vision, specified
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.
"In-network provider" means a health care provider that
contracts with an insurer to provide health care services to an
insured under a managed care plan.
"Mental health care" means any care, treatment, service or
procedure to maintain, diagnose, treat or provide for mental
health, including a medication program and therapeutic
treatment.
"Out-of-network provider" means a health care provider that
does not contract with an insurer to provide health care
services to an insured under the insured's managed care plan.
Section 2. This act shall take effect in 60 days.
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