1Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2act relating to insurance; amending, revising, and
3consolidating the law providing for the incorporation of
4insurance companies, and the regulation, supervision, and
5protection of home and foreign insurance companies, Lloyds
6associations, reciprocal and inter-insurance exchanges, and
7fire insurance rating bureaus, and the regulation and
8supervision of insurance carried by such companies,
9associations, and exchanges, including insurance carried by
10the State Workmen's Insurance Fund; providing penalties; and
11repealing existing laws," providing for oncology benefit
12design.

13The General Assembly of the Commonwealth of Pennsylvania
14hereby enacts as follows:

15Section 1.  The act of May 17, 1921 (P.L.682, No.284), known
16as The Insurance Company Law of 1921, is amended by adding a
17section to read:

18Section 631.1.  Oncology Benefit Design.--(a)  Individual or
19group health insurance policies offered by an insurer providing
20coverage for intravenously administered cancer chemotherapy that
21also provide coverage for orally administered cancer

1chemotherapy shall provide orally administered cancer
2chemotherapy with no less favorable patient cost-sharing than
3for covered intravenously administered chemotherapy. This shall
4include copayments, deductibles, coinsurance provisions and
5maximum out-of-pocket limits that are based upon how the
6chemotherapy is administered to the patient.

7(b)  This section shall apply to individual or group health
8insurance policies offered by an insurer that may offer coverage
9for orally administered or injected chemotherapy as part of a
10prescription drug benefit. This shall include offerings made
11directly through the insurer or an entity that insurer has
12contracted with to provide, deliver, arrange for or reimburse
13for coverage.

14(c)  Compliance with this section cannot be achieved by 
15imposing cost increases to patients for their out-of-pocket 
16costs for those patients currently receiving covered 
17chemotherapy agents regardless of the form of administration.

18(d)  This section shall apply to health insurance policies
19offered, issued or renewed on or after July 1, 2013, in this
20Commonwealth. This section shall not include the following
21policies:

22(1)  Accident only.

23(2)  Fixed indemnity.

24(3)  Limited benefit.

25(4)  Credit.

26(5)  Dental.

27(6)  Vision.

28(7)  Medicare supplement.

29(8)  CHAMPUS (Civilian Health and Medical Program of the
30Uniformed Services) supplement.

1(9)  Long-term care or disability income.

2(10)  Long-term care.

3(11)  Workers' compensation.

4(12)  Automobile medical payment.

5(e)  The term "cancer chemotherapy" when used in this section
6means medication that is prescribed by a physician for the
7purpose of killing or slowing the growth of cancer cells.

8(f)  The term "insurer" when used in this section means a
9company or health insurance entity licensed in this Commonwealth
10to issue individual or group health, sickness or accident policy
11or subscriber contract or certificate or plan that provides
12medical or health care coverage by a health care facility or
13licensed health care provider that is offered or governed under
14this act or the following:

15(1)  The act of December 29, 1972 (P.L.1701, No.364), known
16as the "Health Maintenance Organization Act."

17(2)  The act of May 18, 1976 (P.L.123, No.54), known as the
18"Individual Accident and Sickness Insurance Minimum Standards
19Act."

20(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan
21corporations) or 63 (relating to professional health services
22plan corporations).

23Section 2.  This act shall take effect July 1, 2015.