PRINTER'S NO. 3518
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2848
Session of
2022
INTRODUCED BY FIEDLER, KINKEAD, KENYATTA, MADDEN, HILL-EVANS,
ISAACSON, SANCHEZ, KRAJEWSKI, HOHENSTEIN, DELLOSO, FITZGERALD
AND A. DAVIS, SEPTEMBER 26, 2022
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 26, 2022
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 coverage for abortion services.
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 635.8. Coverage for Abortion Services.--(a) An
insurer that issues, delivers or renews a health insurance
policy or government program in this Commonwealth on or after
the effective date of this section shall provide coverage for a
drug, product or service.
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(b) An insurer may not impose any of the following:
(1) Prior authorization, utilization review, step therapy
requirements or any other restriction or delay on the coverage
required under this section.
(2) A copayment, coinsurance, deductible or any other cost-
sharing requirement for coverage required under this section.
(c) If the FDA has designated a therapeutic equivalent to
another drug, product or service that is available under a
policy or contract, an insurer shall include the original drug,
product or service or, at a minimum, one therapeutic equivalent.
If the FDA has not designated a therapeutic equivalent, the
insurer shall cover the original drug, product or service.
(d) If a drug, product or service is deemed medically
inadvisable by the insured's health care provider, the insurer
shall provide coverage for a medically appropriate drug, product
or service that is prescribed by the insured's health care
provider without a copayment, coinsurance, deductible or other
cost-sharing mechanism.
(e) If a drug, product or service is provided by an out-of-
network health care provider, the insurer shall provide coverage
without imposing a cost-sharing requirement on the insured if
any of the following apply:
(1) There is no in-network provider to provide the drug,
product or service that is geographically accessible or
accessible in a reasonable amount of time as specified under 28
Pa. Code Ch. 9 Subch. H (relating to availability and access).
(2) An in-network provider is unable or unwilling to provide
the drug, product or service in a timely manner.
(f) An insurer shall provide the same coverage for an
insured under this section to the insured's covered spouse or
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domestic partner and covered nonspouse dependent.
(g) An insurer that limits coverage of drugs, devices or
other products in a formulary shall provide for coverage for a
drug, product and service that is not in the formulary if, in
the judgment of the health care provider, the formulary does not
include a drug, device or other product that is medically
necessary.
(h) An insurer shall establish and implement an easily
accessible, transparent and sufficiently expedient process by
which an insured may receive a drug, product and service not in
the insurer's formulary in accordance with this section.
(i) An insurer may not discriminate in the delivery or
coverage of drugs, devices or other products based on the
covered person's actual or perceived race, color, national
origin, sex, sexual orientation, gender identity or expression,
age or disability.
(j) The department shall develop a timely and efficient
process to respond to requests from employers seeking an
exclusion from the coverage requirements under this section. An
employer may request an exclusion from the coverage requirements
under this section by submitting a written request to the
department if the employer meets any of the following
requirements:
(1) The employer is a not-for-profit organization that has
the purpose of inculcating religious values.
(2) The employer primarily employs individuals who share the
religious tenets of the employer.
(3) The employer primarily serves individuals who share the
religious tenets of the employer.
(k) An employer that is granted an exclusion under
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subsection (j) shall provide written notice to prospective
insureds before their enrollment in the insurer's health
insurance policy or government program. The written notice under
this subsection shall list the drugs, devices or other products
that the employer refuses to cover for religious reasons.
(l) If an employer is granted an exclusion under subsection
(j), the following shall apply:
(1) An insured covered under the insurer shall have the
right to directly purchase coverage for the cost of drugs,
devices or other products from the insurer at the prevailing
small group market rate, regardless of whether the insured is
part of a small group market.
(2) The insurer shall provide written notice to insureds
upon enrollment with the insurer of their right to directly
purchase coverage for the cost of drugs, devices or other
products under clause (1). The written notice under this clause
shall also advise the enrollees of the additional premium for
coverage of drugs, devices or other products.
(m) A prospective insured or insured who believes that the
prospective insured or insured has been adversely affected by an
act or practice of an insurer in violation of this section may
file any of the following:
(1) A complaint with the Insurance Commissioner, who shall
adjudicate the complaint consistent with 2 Pa.C.S. (relating to
administrative law and procedure) and address the violation
through means appropriate to the nature and extent of the
violation, which may include a cease and desist order,
injunctive relief, restitution, suspension or revocation of a
certificate of authority or license, civil penalties and
reimbursement of costs or reasonable attorney fees incurred by
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the aggrieved individual in bringing the complaint.
(2) A civil action against the insurer in a court of
competent jurisdiction, which, upon proof of the violation by a
preponderance of the evidence, shall award appropriate relief to
the aggrieved individual, including temporary, preliminary or
permanent injunctive relief, compensatory or punitive damages,
the costs of suit, reasonable attorney fees and reasonable fees
for the aggrieved individual's expert witnesses. At any time
before the rendering of a final judgment under this clause, the
aggrieved individual may elect to recover, in lieu of actual
damages, an award of statutory damages in the amount of five
thousand dollars ($5,000) for each violation.
(n) As used in this section, the following words and phrases
shall have the meanings given to them under this subsection:
"Department." The Insurance Department of the Commonwealth.
"Drug, product or service." Abortion as defined in 18
Pa.C.S. § 3203 (relating to definitions) .
"FDA." The United States Food and Drug Administration.
"Government program." Any of the following:
(1) The medical assistance program under Subarticle (f) of
Article IV of the act of June 13, 1967 (P.L.31, No.21), known as
the "Human Services Code."
(2) The Children's Health Insurance Program under Article
XXIII-A.
"Health care provider." A person who is licensed, certified
or otherwise approved by the Commonwealth to provide health care
services.
"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
subscriber contract, certificate or plan that provides medical
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or health care coverage by a health care facility or health care
provider and is offered by or is governed under any of the
following:
(i) Subarticle (f) of Article IV of the "Human Services
Code."
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) The act of May 18, 1976 (P.L.123, No.54), known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(iv) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
(v) This act.
(2) The term does not include any of the following:
(i) A health benefit plan that is a grandfathered health
plan as defined in section 1251 of the Patient Protection and
Affordable Care Act (Public Law 111-148, 42 U.S.C. § 18011).
(ii) Any of the following types of insurance:
(A) Accident only.
(B) Fixed indemnity.
(C) Limited benefit.
(D) Credit.
(E) Dental.
(F) Vision.
(G) Specified disease.
(H) Medicare supplement.
(I) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(J) Long-term care or disability income.
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(K) Workers' compensation.
(L) Automobile medical payment.
"Insurer." An entity that issues an individual or a group
health insurance policy or government program.
"Therapeutic equivalent." A drug, device or other product
that meets all of the following criteria:
(1) The drug, device or other product can be expected to
have the same clinical effect and safety profile when
administered to a patient under the conditions specified in the
labeling.
(2) The drug, device or other product is FDA-approved as
safe and effective.
(3) The drug, device or other product is a pharmaceutical
equivalent that:
(i) contains identical amounts of the same active drug
ingredient in the same dosage form and route of administration;
and
(ii) meets compendial standards or other applicable
standards of strength, quality, purity and identity.
(4) The drug, device or other product is a bioequivalent
that:
(i) does not present a known or potential bioequivalence
problem and meets an acceptable in vitro standard; or
(ii) is shown to meet an appropriate bioequivalence standard
if the drug, device or other product does present a known or
potential bioequivalence problem.
(5) The drug, device or other product is adequately labeled.
(6) The drug, device or other product is manufactured in
compliance with current good manufacturing practice regulations.
Section 2. This act shall effect in 60 days.
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