PRIOR PRINTER'S NO. 260 PRINTER'S NO. 2719
No. 239 Session of 1987
INTRODUCED BY COLE, DOMBROWSKI, FEE, ARTY AND PRESSMAN,
FEBRUARY 4, 1987
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, JANUARY 25, 1988
AN ACT
1 Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An <--
2 act relating to insurance; amending, revising, and
3 consolidating the law providing for the incorporation of
4 insurance companies, and the regulation, supervision, and
5 protection of home and foreign insurance companies, Lloyds
6 associations, reciprocal and inter-insurance exchanges, and
7 fire insurance rating bureaus, and the regulation and
8 supervision of insurance carried by such companies,
9 associations, and exchanges, including insurance carried by
10 the State Workmen's Insurance Fund; providing penalties; and
11 repealing existing laws," providing for coverage of cancer
12 treatment.
13 PROVIDING FOR INSURANCE BENEFITS FOR CANCER CHEMOTHERAPY AND <--
14 CANCER HORMONE TREATMENTS.
15 The General Assembly of the Commonwealth of Pennsylvania
16 hereby enacts as follows:
17 Section 1. The act of May 17, 1921 (P.L.682, No.284), known <--
18 as The Insurance Company Law of 1921, is amended by adding a
19 section to read:
20 Section 631. Cancer Treatment.--(a) All group policies
21 covered by subdivision (b) of this article providing hospital or
22 medical-surgical coverage and all group subscriber contracts or
1 certificates issued by any entity subject to 40 Pa.C.S. Ch. 61
2 (relating to hospital plan corporations) or 63 (relating to
3 professional health services plan corporations), the act of
4 December 29, 1972 (P.L.1701, No.364), known as the "Health
5 Maintenance Organization Act," or the act of July 29, 1977
6 (P.L.105, No.38), known as the "Fraternal Benefit Society Code,"
7 providing hospital or medical-surgical coverage, shall include
8 within the coverage, reimbursement for cancer chemotherapy and
9 cancer hormone treatments and services. The coverage shall
10 specifically provide for reimbursement for cancer chemotherapy
11 and cancer hormone therapy approved by the United States Food
12 and Drug Administration for commercial use in the treatment of
13 cancer and not approved for investigative or experimental
14 purposes and for the insured or any other person covered by the
15 policy, contract or certificate, or health services
16 reimbursement program to be entitled to reimbursement for cancer
17 chemotherapy and cancer hormone treatments, whether performed in
18 a physician's office, in an outpatient department of a hospital
19 or as a hospital outpatient, or in any other medically
20 appropriate treatment setting. This subsection shall not apply
21 to policies, contracts or certificates of group or individual
22 health or sickness insurance which provide coverage or
23 reimbursement only for accidents, coverage or reimbursement
24 based solely on the number of days an insured is hospitalized or
25 coverage or reimbursement only when the insured is hospitalized
26 as an inpatient in a hospital.
27 (b) The benefits specified in subsection (a) may be provided
28 through a combination of such policies, contracts or
29 certificates. The benefits specified in subsection (a) may be
30 provided through prospective payment plans.
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1 (c) Reasonable deductible or copayment plans, or both, may
2 be applied to benefits paid to or on behalf of patients during
3 the course of cancer chemotherapy and cancer hormone treatments
4 but in no case shall be less favorable than those applied to
5 similar classes or categories of treatment for physical illness
6 generally in each policy.
7 (d) Cancer chemotherapy and cancer hormone treatments and
8 services shall be subject to the same terms and conditions as
9 other benefits as set forth in the policies, contracts or
10 certificates, and each treatment shall be covered by an
11 individualized treatment plan which is subject to
12 precertification and concurrent utilization and peer review.
13 Section 2. This act shall take effect immediately.
14 SECTION 1. REIMBURSEMENT FOR CANCER THERAPY. <--
15 WHENEVER ANY GROUP HEALTH, SICKNESS OR ACCIDENT INSURANCE
16 POLICY OR SUBSCRIBER CONTRACT OR CERTIFICATE ISSUED BY ANY
17 ENTITY SUBJECT TO 40 PA.C.S. CHS. 61 (RELATING TO HOSPITAL PLAN
18 CORPORATIONS) AND 63 (RELATING TO PROFESSIONAL HEALTH SERVICES
19 PLAN CORPORATIONS), THE ACT OF MAY 17, 1921 (P.L.682, NO.284),
20 KNOWN AS THE INSURANCE COMPANY LAW OF 1921 OR THE ACT OF JULY
21 29, 1977 (P.L.105, NO.38), KNOWN AS THE FRATERNAL BENEFIT
22 SOCIETY CODE, PROVIDING HOSPITAL OR MEDICAL-SURGICAL COVERAGE
23 INCLUDES WITHIN THE COVERAGE BENEFITS FOR CANCER CHEMOTHERAPY
24 AND CANCER HORMONE TREATMENTS AND SERVICES APPROVED BY THE
25 UNITED STATES FOOD AND DRUG ADMINISTRATION FOR GENERAL USE IN
26 TREATMENT OF CANCER, THE COVERED INDIVIDUAL SHALL BE ENTITLED TO
27 BENEFITS FOR CANCER CHEMOTHERAPY AND CANCER HORMONE TREATMENTS,
28 WHETHER PERFORMED IN A PHYSICIAN'S OFFICE, IN AN OUTPATIENT
29 DEPARTMENT OF A HOSPITAL, IN A HOSPITAL AS A HOSPITAL INPATIENT
30 OR IN ANY OTHER MEDICALLY APPROPRIATE TREATMENT SETTING.
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1 SECTION 2. EXISTING BENEFITS.
2 NOTHING IN THIS ACT SHALL SERVE TO DIMINISH THE BENEFITS OF
3 ANY INSURED OR SUBSCRIBER IN EFFECT ON THE EFFECTIVE DATE OF
4 THIS ACT, NOR PREVENT THE OFFERING OR ACCEPTANCE OF BENEFITS
5 WHICH EXCEED THE MINIMUM BENEFITS REQUIRED BY THIS ACT.
6 SECTION 3. EFFECTIVE DATE.
7 THIS ACT SHALL TAKE EFFECT IMMEDIATELY.
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