PRINTER'S NO. 1469
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1084
Session of
2015
INTRODUCED BY TARTAGLIONE, COSTA AND FONTANA, DECEMBER 11, 2015
REFERRED TO BANKING AND INSURANCE, DECEMBER 11, 2015
AN ACT
Requiring health insurance policies to provide coverage for
postexposure prophylaxis HIV medication.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the PEP for
Pennsylvania Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Postexposure prophylaxis HIV medication." Any medication
that is approved by the United States Food and Drug
Administration that can be taken as a prophylaxis to prevent the
transmission of the HIV virus.
"Health insurance policy." An individual or group health
insurance policy, contract or plan that provides medical or
health care coverage by any health care facility or licensed
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health care provider on an expense-incurred service or prepaid
basis that is offered by or is governed under any of the
following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
The term does not include accident only, fixed indemnity,
limited benefit, credit, dental, vision, specified disease,
Medicare supplement, Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement, long-term care or
disability income, workers' compensation or automobile medical
payment insurance.
Section 3. Mandated coverage.
(a) General rule.--Every health insurance policy that is
delivered, issued for delivery, renewed, extended or modified in
this Commonwealth on or after the effective date of this section
shall provide coverage for the expenses of any postexposure
prophylaxis HIV medication.
(b) Specialty tier.--Insurance providers may not move any
postexposure prophylaxis HIV medication into a specialty tier
solely for monetary gains.
(c) Counseling.--No health care plan may impose counseling
from an infectious disease specialist or immunologist in order
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to receive postexposure prophylaxis HIV medication, unless
medically necessary.
Section 4. Effective date.
This act shall take effect in 60 days.
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