PRINTER'S NO. 4829
No. 3042 Session of 2006
INTRODUCED BY GANNON, DeLUCA, KOTIK, YOUNGBLOOD, JAMES, DALEY,
LEDERER AND BARRAR, OCTOBER 18, 2006
REFERRED TO COMMITTEE ON INSURANCE, OCTOBER 18, 2006
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," prohibiting discrimination against
12 certain willing providers by health care benefit plan payers.
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. The act of May 17, 1921 (P.L.682, No.284), known
16 as The Insurance Company Law of 1921, is amended by adding an
17 article to read:
18 ARTICLE XVIII-A
19 HEALTH INSURANCE ANTIDISCRIMINATION
20 Section 1801-A. Definitions.
21 The following words and phrases when used in this article
22 shall have the meanings given to them in this section unless the
1 context clearly indicates otherwise:
2 "Clinical laboratory." A place, establishment or institution
3 organized and operated primarily for the performance of
4 bacteriological, biochemical, microscopical, serological or
5 parasitological tests by the practical application of one or
6 more of the fundamental sciences to material originating from
7 the human body, by the use of specialized apparatus, equipment
8 and methods, for the purpose of obtaining scientific data which
9 may be used as an aid to ascertain the state of health. The term
10 includes, but is not limited to, independent, hospital,
11 industrial, State, county and municipal laboratories and
12 clinical laboratories operated in private offices and clinics of
13 practitioners of the healing arts.
14 "Health care benefit plan." A health insurance policy,
15 contract or plan that provides health care to participants or
16 beneficiaries directly or through insurance, reimbursement or
17 otherwise.
18 "Health insurer." Any insurer who issues an individual or
19 group health insurance policy, subscriber contract, certificate
20 or plan which provides medical or health care coverage by any
21 health care facility or licensed health care provider which is
22 offered by or is governed under this act or any of the
23 following:
24 (1) 40 Pa.C.S. Ch. 61 (relating to hospital plan
25 corporations) or 63 (relating to professional health services
26 plan corporations).
27 (2) This act, including any preferred provider
28 organization subject to section 630.
29 (3) The act of December 29, 1972 (P.L.1701, No.364),
30 known as the Health Maintenance Organization Act.
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1 (4) Article 24 of the act of July 10, 2002 (P.L.749,
2 No.110), entitled "An act amending the act of May 17, 1921
3 (P.L.682, No.284), entitled 'An act relating to insurance;
4 amending, revising, and consolidating the law providing for
5 the incorporation of insurance companies, and the regulation,
6 supervision, and protection of home and foreign insurance
7 companies, Lloyds associations, reciprocal and inter-
8 insurance exchanges, and fire insurance rating bureaus, and
9 the regulation and supervision of insurance carried by such
10 companies, associations, and exchanges, including insurance
11 carried by the State Workmen's Insurance Fund; providing
12 penalties; and repealing existing laws,' further providing
13 for requisites for foreign companies to do business; deleting
14 provisions relating to admitted assets; further providing for
15 standard nonforfeiture law for individual deferred annuities
16 and for title insurance agents; further defining 'wet marine
17 and transportation insurance'; further providing for
18 placement of surplus lines insurance, for requirements for
19 eligible surplus lines insurers, for surplus lines licensee's
20 duty to notify insured, for declarations, for licensing of
21 surplus lines licensee, for records of surplus lines
22 licensee, for suspension, revocation or nonrenewal of surplus
23 lines licensee's license and for service of process in
24 actions against surplus lines insurer; providing for
25 fraternal benefit societies; and making a repeal."
26 Section 1802-A. Discrimination against willing provider
27 prohibited.
28 (a) General rule.--A health insurer shall be required to
29 contract with and to accept as a health care benefit plan
30 participant any clinical laboratory. A health care insurance
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1 policy shall not discriminate against any clinical laboratory
2 that agrees to accept negotiated payment levels and to adhere to
3 quality standards established by the health care payer.
4 (b) Use of terms.--The term "health insurance," "health
5 benefit plan" or other similar term used in any statute enacted
6 after the effective date of this statute shall not include,
7 unless specifically provided, the following types of insurance
8 or any combination thereof:
9 (1) Hospital indemnity.
10 (2) Accident.
11 (3) Specified disease.
12 (4) Disability income.
13 (5) Dental.
14 (6) Vision.
15 (7) Civilian Health and Medical Program of the Uniformed
16 Services (CHAMPUS) supplement.
17 (8) Medicare supplement.
18 (9) Long-term care.
19 (10) Other limited benefit plans.
20 Section 2. This act shall take effect in 60 days.
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