PRINTER'S NO.  158

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

SENATE BILL

 

No.

193

Session of

2011

  

  

INTRODUCED BY BOSCOLA, WILLIAMS, TARTAGLIONE, LEACH, BREWSTER, FONTANA AND RAFFERTY, JANUARY 19, 2011

  

  

REFERRED TO BANKING AND INSURANCE, JANUARY 19, 2011  

  

  

  

AN ACT

  

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Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An

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act relating to insurance; amending, revising, and

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consolidating the law providing for the incorporation of

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insurance companies, and the regulation, supervision, and

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protection of home and foreign insurance companies, Lloyds

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associations, reciprocal and inter-insurance exchanges, and

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fire insurance rating bureaus, and the regulation and

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supervision of insurance carried by such companies,

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associations, and exchanges, including insurance carried by

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the State Workmen's Insurance Fund; providing penalties; and

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repealing existing laws," in health and accident insurance,

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providing for insurance coverage for infertility treatment

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services.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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Section 1.  The act of May 17, 1921 (P.L.682, No.284), known

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as The Insurance Company Law of 1921, is amended by adding a

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section to read:

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Section 633.1.  Coverage for Infertility Treatment.--(a)

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Every health insurance policy that provides pregnancy-related

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benefits and is delivered, issued, executed or renewed in this

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Commonwealth on or after the effective date of this section

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shall provide coverage for the expenses of diagnosis and

 


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treatment of infertility, including, but not limited to, in

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vitro fertilization, embryo transfer, artificial insemination,

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gamete intrafallopian tube transfer, zygote intrafallopian tube

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transfer and low tubal ovum transfer.

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(b)  The coverage required under subsection (a) of this

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section may impose the following restrictions:

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(1)  Exclude reversal of elective sterilization or use of

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assisted reproductive techniques when infertility is the result

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of elective sterilization.

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(2)  Impose restrictions or waiting periods before assisted

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reproductive techniques may be employed. Any and all

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restrictions or waiting periods imposed must be within the

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recommended treatment guidelines issued by the American Society

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for Reproductive Medicine or the American College of

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Obstetricians and Gynecologists.

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(3)  Exclude coverage for women beyond childbearing years.

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(4)  Restrict coverage for assisted reproductive techniques

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to the policyholder and dependent spouse. Any and all treatments

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to remedy conditions which could impair fertility must be

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covered for policyholder and all dependents, including minor

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children.

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(5)  Require in vitro fertilization, gamete intrafallopian

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tube transfer or zygote intrafallopian tube transfer be

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performed at medical facilities that conform to the American

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College of Obstetricians and Gynecologists guidelines for in

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vitro fertilization clinics or to the American Society for

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Reproductive Medicine minimal standards for programs of in vitro

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fertilization.

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(6)  Impose a limitation of three assisted reproductive

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technology procedures that a covered individual may attempt.

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(7)  Require copayment or deductibles for assisted

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reproductive technology treatments. Any copayment or deduction

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may not exceed those applied to pregnancy-related benefits under

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the same policy, contract or plan.

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(c)  The procedures required to be covered under this section

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may be contained in any policy or plan issued to a religious

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institution or organization or to any entity sponsored by a

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religious institution or organization that finds the procedure

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required to be covered under this section to violate its

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religious and moral teachings and beliefs.

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(d)  (1)  The term "health insurance policy" when used in

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this section means individual or group health insurance policy,

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contract or plan which provides medical or health care coverage

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by any health care facility or licensed health care provider on

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an expense-incurred service or prepaid basis and which is

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offered by or is governed under any of the following:

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(i)  This act.

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(ii)  Subdivision (f) of Article IV of the act of June 13,

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1967 (P.L.31, No.21), known as the "Public Welfare Code."

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

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as the "Health Maintenance Organization Act."

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

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"Individual Accident and Sickness Insurance Minimum Standards

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Act."

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(v)  A nonprofit corporation subject to 40 Pa.C.S. Ch. 61 

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(relating to hospital plan corporations) or 63 (relating to

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professional health services plan corporations).

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(2)  The term "infertility" when used in this section means

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the inability to conceive after one year of unprotected sexual

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intercourse or the inability to sustain a successful pregnancy.

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Section 2.  This act shall take effect in 60 days.

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