Regular Session 2017-2018 House Bill 2113 P.N. 3043

PRINTER'S NO. 3043

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

2113

Session of

2018

INTRODUCED BY OBERLANDER, ROTHMAN, MILLARD, JAMES, CORR,

PASHINSKI, ZIMMERMAN, CHARLTON, WATSON, HARPER, DIAMOND,

KORTZ, FARRY, MURT, DiGIROLAMO, NELSON, SONNEY AND COX,

FEBRUARY 26, 2018

REFERRED TO COMMITTEE ON CONSUMER AFFAIRS, FEBRUARY 26, 2018

AN ACT

Amending the act of July 22, 1974 (P.L.589, No.205), entitled

"An act relating to unfair insurance practices; prohibiting

unfair methods of competition and unfair or deceptive acts

and practices; and prescribing remedies and penalties,"

further providing for unfair methods of competition and

unfair or deceptive acts or practices defined.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Section 5(a) of the act of July 22, 1974

(P.L.589, No.205), known as the Unfair Insurance Practices Act,

is amended by adding a paragraph to read:

Section 5. Unfair Methods of Competition and Unfair or

Deceptive Acts or Practices Defined.--(a) "Unfair methods of

competition" and "unfair or deceptive acts or practices" in the

business of insurance means:

* * *

(15) Altering the coverage provided by a health insurance

policy, including, but not limited to, raising the premium,

copayment, coinsurance or deductible or denying or otherwise

failing to provide continued coverage for a health care benefit

that was included in the insured's health insurance policy and

when the insured has already received the health care benefit.

The following shall apply:

(i) This paragraph shall not apply to health care benefits

obtained by an insured through fraudulent or criminal activity

or subject to:

(A) a statement issued by the United States Food and Drug

Administration (FDA) calling into question the clinical safety

of the benefit; or

(B) a notice provided by the manufacturer of a prescription

drug to the FDA related to a manufacturing discontinuance or

potential discontinuance of the drug.

(ii) In addition to any other penalties authorized by this

act, a violation of this paragraph shall be deemed a violation

of the act of December 17, 1968 (P.L.1224, No.387), known as the

"Unfair Trade Practices and Consumer Protection Law." Nothing in

this act shall preclude an insured from exercising any right

provided under the "Unfair Trade Practices and Consumer

Protection Law" and the following shall apply:

(A) The Office of Attorney General shall accept complaints

from an insured pursuant to this section. An insured may file a

complaint with the Bureau of Consumer Protection of the Office

of Attorney General.

(B) In addition to any other penalty under this act, a civil

penalty of up to $1,000 shall be imposed on a health insurer who

violates this paragraph.

(iii) As used in this paragraph:

(A) "Biological product" shall have the same meaning as

"biological product" in the Public Health Service Act (58 Stat.

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682, 42 U.S.C. § 201 et seq.).

(B) "Health care benefits" means all products, services,

procedures, treatments and prescription drugs for which coverage

is provided under a health insurance policy offered by a health

insurer.

individual health or sickness or accident insurance policy,

subscriber contract or certificate issued by an entity subject

to any one of the following:

(a) The act of May 17, 1921 (P.L.682, No.284), known as "The

Insurance Company Law of 1921," including section 630 and

Article XXIV of that act.

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

as the "Health Maintenance Organization Act."

corporations) or 63 (relating to professional health services

plan corporations).

(II) 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.

(D) "Health insurer" means an entity licensed by the

department with accident and health authority to issue a policy,

subscriber contract, certificate or plan that provides medical

or health care coverage that is offered or governed under any of

the following:

(I) The "Insurance Company Law of 1921," including section

630 and Article XXIV of that act.

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(II) The "Health Maintenance Organization Act."

(III) 40 Pa.C.S. Chs. 61 or 63.

(E) "Insured" means a person who receives coverage under a

health insurance policy and has paid all premiums due under the

contract or policy. As used in this paragraph, the term shall

include all individuals named in a health insurance policy

issued by a health insurer.

(F) "Prescription drug" means a controlled substance, other

drug, including a biological product, or device for medication

dispensed by order of an appropriately licensed medical

professional.

(iv) This paragraph shall not be interpreted to impact or

inhibit the applicability of any provision of act of November

24, 1976 (P.L.1163, No.259), referred to as the Generic

Equivalent Drug Law.

(v) Nothing in this paragraph shall be construed to prohibit

a health insurer from adding health care benefits during the

term of a health insurance policy.

* * *

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

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