THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY WANSACZ, BELFANTI, BISHOP, CALTAGIRONE, COHEN, DALEY, DEASY, EVERETT, HORNAMAN, MYERS, SIPTROTH, K. SMITH, WAGNER AND YOUNGBLOOD, JUNE 15, 2010

REFERRED TO COMMITTEE ON INSURANCE, JUNE 15, 2010  

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," providing for physical therapy

benefit design.

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 631.1.  Physical Therapy Benefit Design.--(a)  

Individual or group health insurance policies offered by an

insurer providing coverage for physical therapy shall provide

coverage with no less favorable patient cost-sharing than for

covered services provided by a primary care provider as defined

in section 2102. This shall include copayments, deductibles,

coinsurance provisions and maximum out-of-pocket limits.

(b)  Compliance with this section cannot be achieved by

imposing an increase in patient out-of-pocket costs regardless

of the form of administration.

(c)  This section shall apply to health insurance policies

offered, issued or renewed on or after July 1, 2011, in this

Commonwealth. This section shall not include the following

policies:

(1)  Accident only.

(2)  Fixed indemnity.

(3)  Limited benefit.

(4)  Credit.

(5)  Dental.

(6)  Vision.

(7)  Medicare supplement.

(8)  CHAMPUS (Civilian Health and Medical Program of the

Uniformed Services) supplement.

(9)  Long-term care or disability income.

(10)  Long-term care.

(11)  Workers' compensation.

(12)  Automobile medical payment.

(d)  The term "physical therapy" when used in this section

shall have the same meaning as defined in section 2 of the act

of October 10, 1975 (P.L.383, No.110), known as the "Physical

Therapy Practice Act."

(e)  The term "insurer" when used in this section means a

company or health insurance entity licensed in this Commonwealth

to issue individual or group health, sickness or accident policy

or subscriber contract or certificate or plan that provides

medical or health care coverage by a health care facility or

licensed health care provider that is offered or governed under

this act or the following:

(1)  The act of December 29, 1972 (P.L.1701, No.364), known

as the "Health Maintenance Organization Act."

(2)  The act of May 18, 1976 (P.L.123, No.54), known as the

"Individual Accident and Sickness Insurance Minimum Standards

Act."

(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan

corporations) or 63 (relating to professional health services

plan corporations).

Section 2.  This act shall apply to all policies issued or

renewed on or after January 1, 2011.

Section 3.  This act shall take effect in 60 days.