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                                                       PRINTER'S NO. 587

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 544 Session of 2007


        INTRODUCED BY WONDERLING, BOSCOLA, ERICKSON, LOGAN, RAFFERTY,
           O'PAKE, COSTA, KITCHEN, ORIE AND RHOADES, MARCH 19, 2007

        REFERRED TO BANKING AND INSURANCE, MARCH 19, 2007

                                     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 reimbursement for
    12     food and food products for inherited metabolic diseases.

    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 a
    17  section to read:
    18     Section 635.2.  Reimbursement for Food and Food Products for
    19  Inherited Metabolic Diseases.--(a)  As used in this section:
    20     (1)  "Inherited metabolic disease" means a disease caused by
    21  an inherited abnormality of body chemistry. The term includes a
    22  disease for which the Commonwealth screens newborn babies.


     1     (2)  "Low protein modified food product" means a food product
     2  that is specially formulated to have less than one gram of
     3  protein per serving and is intended to be used under the
     4  direction of a physician for the dietary treatment of an
     5  inherited metabolic disease. The term does not include a natural
     6  food that is naturally low in protein.
     7     (3)  "Medical food" means a food that is intended for the
     8  dietary treatment of a disease or condition for which
     9  nutritional requirements are established by medical evaluation
    10  and is formulated to be consumed or administered enterally under
    11  the direction of a physician.
    12     (b)  Except to the extent already covered under another
    13  policy, any individual or group health, sickness and accident
    14  insurance policy, group health insurance plans/policies and all
    15  other forms of managed/capitated care plans/policies or
    16  subscriber contract or certificate issued by any entity subject
    17  to 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or
    18  63 (relating to professional health services plan corporations)
    19  or the act of December 29, 1972 (P.L.1701, No.364), known as the
    20  "Health Maintenance Organization Act," or this act providing
    21  hospital or medical/surgical coverage, including medical
    22  assistance, shall provide coverage of medical foods and low
    23  protein modified food products for the treatment of an inherited
    24  metabolic disease if prescribed as medically necessary for the
    25  treatment of the inherited metabolic disease by and administered
    26  under the direction of a physician legally authorized to
    27  prescribe such items under law. The benefits specified in this
    28  section may be provided through a combination of policies,
    29  contracts, certificates or riders, including major medical
    30  contracts.
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     1     (c)  This section does not include the following policies:
     2  accident only, fixed indemnity, limited benefit, credit, dental,
     3  vision, specified disease, Medicare supplement, Civilian Health
     4  and Medical Program of the Uniformed Services (CHAMPUS)
     5  supplement, long-term care, disability income, workers'
     6  compensation or automobile medical payment.
     7     Section 2.  This act shall take effect in 60 days.
















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