PRINTER'S NO. 1010
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
828
Session of
2021
INTRODUCED BY J. WARD, CAPPELLETTI, COLLETT, MENSCH AND
BREWSTER, JULY 26, 2021
REFERRED TO BANKING AND INSURANCE, JULY 26, 2021
AN ACT
Amending the act of July 22, 1974 (P.L.589, No.205), entitled
"An act relating to unfair insurance practices; prohibiting
unfair methods of competition and unfair or deceptive acts
and practices; and prescribing remedies and penalties,"
further providing for unfair methods of competition and
unfair or deceptive acts or practices defined.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 5(a) of the act of July 22, 1974
(P.L.589, No.205), known as the Unfair Insurance Practices Act,
is amended by adding a paragraph to read:
Section 5. Unfair Methods of Competition and Unfair or
Deceptive Acts or Practices Defined.--(a) "Unfair methods of
competition" and "unfair or deceptive acts or practices" in the
business of insurance means:
* * *
(15) Altering the coverage provided by a health insurance
policy, including, but not limited to, raising the premium,
copayment, coinsurance or deductible or denying or otherwise
failing to provide continued coverage for a health care benefit
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that was included in the insured's health insurance policy and
when the insured has already received the health care benefit.
The following shall apply:
(i) This paragraph shall not apply to health care benefits
obtained by an insured through fraudulent or criminal activity
or subject to:
(A) a statement issued by the United States Food and Drug
Administration (FDA) calling into question the clinical safety
of the benefit; or
(B) a notice provided by the manufacturer of a prescription
drug to the FDA related to a manufacturing discontinuance or
potential discontinuance of the drug.
(ii) In addition to any other penalties authorized by this
act, a violation of this paragraph shall be deemed a violation
of the act of December 17, 1968 (P.L.1224, No.387), known as the
"Unfair Trade Practices and Consumer Protection Law." Nothing in
this act shall preclude an insured from exercising any right
provided under the "Unfair Trade Practices and Consumer
Protection Law." A civil penalty of up to one thousand dollars
($1,000) shall be imposed on a health insurer who violates this
paragraph.
(iii) As used in this paragraph:
(A) "Biological product" shall have the same meaning as
"biological product" in the Public Health Service Act (58 Stat.
682, 42 U.S.C. ยง 201 et seq.).
(B) "Health care benefits" means all products, services,
procedures, treatments and prescription drugs for which coverage
is provided under a health insurance policy offered by a health
insurer.
(C) (I) "Health insurance policy" means a group or
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individual health or sickness or accident insurance policy,
subscriber contract or certificate issued by an entity subject
to any one of the following:
(a) The act of May 17, 1921 (P.L.682, No.284), known as "The
Insurance Company Law of 1921," including section 630 and
Article XXIV of that act.
(b) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(c) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(II) 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.
(D) "Health insurer" means an entity licensed by the
Insurance Department with accident and health authority to issue
a policy, subscriber contract, certificate or plan that provides
medical or health care coverage that is offered or governed
under any of the following:
(I) "The Insurance Company Law of 1921," including section
630 and Article XXIV of that act.
(II) The "Health Maintenance Organization Act."
(III) 40 Pa.C.S. Ch. 61 or 63.
(E) "Insured" means a person who receives coverage under a
health insurance policy and has paid all premiums due under the
contract or policy. As used in this paragraph, the term shall
include all individuals named in a health insurance policy
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issued by a health insurer.
(F) "Prescription drug" means a controlled substance, other
drug, including a biological product, or device for medication
dispensed by order of an appropriately licensed medical
professional.
(iv) This paragraph shall not be interpreted to impact or
inhibit the applicability of any provision of the act of
November 24, 1976 (P.L.1163, No.259), referred to as the
"Generic Equivalent Drug Law."
(v) Nothing in this paragraph shall be construed to prohibit
a health insurer from adding health care benefits during the
term of a health insurance policy.
* * *
Section 2. This act shall take effect in 60 days.
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