PRIOR PRINTER'S NO. 456
PRINTER'S NO. 3616
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
471
Session of
2019
INTRODUCED BY SCHWEYER, KINSEY, McNEILL, OTTEN, BARRAR,
READSHAW, MADDEN, DONATUCCI, NEILSON, SAMUELSON, SCHLOSSBERG,
YOUNGBLOOD, D. MILLER, MULLERY, CONKLIN, A. DAVIS, ISAACSON,
DEASY, SOLOMON, FREEMAN, WARREN, KORTZ, CIRESI, CALTAGIRONE,
FRANKEL, HILL-EVANS, MARKOSEK, GOODMAN, DeLUCA, MATZIE, SIMS,
DERMODY, MULLINS, STURLA, DALEY, SAPPEY, T. DAVIS, GALLOWAY,
SANCHEZ, BRIGGS, ZABEL, WILLIAMS, MALAGARI AND PASHINSKI,
FEBRUARY 11, 2019
AS AMENDED, COMMITTEE ON INSURANCE, HOUSE OF REPRESENTATIVES,
APRIL 27, 2020
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," in health and accident insurance,
prohibiting exclusions for preexisting conditions AND
PROVIDING FOR COVERAGE FOR GENERAL ASSEMBLY.
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 SECTIONS to read:
Section 635.8. Exclusions For Preexisting Conditions.--(a)
A health insurer shall be prohibited from discriminating against
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a qualified individual or a qualified group based on a
preexisting medical condition.
(b) Methods of discriminating based on preexisting medical
conditions shall include:
(1) refusing to sell, offer or issue a health insurance
policy to a qualified individual or a qualified group due to a
preexisting medical condition;
(2) selling, offering or issuing a health insurance policy
to a qualified individual or a qualified group that excludes
coverage for a preexisting medical condition;
(3) considering a qualified individual's or qualified
group's prior medical history in the medical underwriting
process;
(4) requiring or requesting a qualified individual or a
qualified group to provide information regarding prior medical
history as part of the health insurer's application or
enrollment process; or
(5) any other method or action of a health insurer that the
Insurance Commissioner deems a limitation or exclusion of
benefits based on the fact that a preexisting medical condition
was present before the effective date of coverage, or, if
coverage is denied, the date of the denial, under a qualified
individual's or a qualified group's health insurance policy.
(c) This section shall apply as follows:
(1) For health insurance policies for which either rates or
forms are required to be filed with the Insurance Department or
the Federal Government, this section shall apply to any policy
for which a form or rate is first filed on or after the
effective date of this section.
(2) For health insurance policies for which neither rates
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nor forms are required to be filed with the Insurance Department
or the Federal Government, this section shall apply to any
policy issued or renewed on or after one hundred eighty days
after the effective date of this section.
(d) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Government program." Any of the following:
(1) The Commonwealth's medical assistance program
established under the act of June 13, 1967 (P.L.31, No.21),
known as the "Human Services Code."
(2) A program under Article XXIII-A.
"Health insurance policy." Any individual or group health,
sickness or accident policy, or subscriber contract or
certificate offered, issued or renewed by a health insurer. The
term does not include any of the following types of insurance:
(1) Accident only.
(2) Fixed indemnity.
(3) Limited benefit.
(4) Credit.
(5) Dental.
(6) Vision.
(7) Specified disease.
(8) Medicare supplement.
(9) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(10) Long-term care or disability income.
(11) Workers' compensation.
(12) Automobile medical payment.
"Health insurer." An entity that issues a health insurance
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policy and is subject to the following:
(1) this act, including, but not limited to, section 630 and
Article XXIV;
(2) the act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act"; or
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"Preexisting medical condition." A physical or mental
condition, including, but not limited to, a disease, an illness,
an injury, pregnancy or a genetic defect for which medical
advice, diagnosis, care or treatment has been recommended or
received prior to the effective date of coverage.
"Qualified group." Any of the following:
(1) A group of qualified individuals covered or applying for
coverage under the same health insurance policy.
(2) A group of individuals covered under an employer
sponsored group health insurance policy.
"Qualified individual." Any of the following:
(1) An individual who is under nineteen (19) years of age.
(2) An individual who:
(i) is covered or applying for coverage under a health
insurance policy; and
(ii) has had health coverage under a health insurance policy
or government program for at least nine months of the twelve
consecutive month period immediately preceding the date of
application or enrollment.
Section 2. This act shall take effect in 30 days.
SECTION 635.9. COVERAGE FOR GENERAL ASSEMBLY.--NO LATER THAN
JULY 1, 2020, OR THE CONCLUSION OF THE CONTRACT FOR HEALTH
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INSURANCE COVERAGE THAT WAS IN EFFECT ON THE EFFECTIVE DATE OF
THIS SECTION, WHICHEVER OCCURS LATER, ALL MEMBERS, OFFICERS AND
EMPLOYES OF THE SENATE OR THE HOUSE OF REPRESENTATIVES SHALL
ONLY PARTICIPATE IN HEALTH INSURANCE COVERAGE UNDER THE PATIENT
PROTECTION AND AFFORDABLE CARE ACT (PUBLIC LAW 111-148, 124
STAT. 119) OR ITS SUCCESSOR.
SECTION 2. THE PROVISIONS OF THIS ACT ARE NONSEVERABLE. IF
ANY PROVISION OF THIS ACT OR ITS APPLICATION TO ANY PERSON OR
CIRCUMSTANCE IS HELD INVALID, THE REMAINING PROVISIONS OR
APPLICATIONS OF THIS ACT ARE VOID AB INITIO. THIS
NONSEVERABILITY CLAUSE IS CONTROLLING.
SECTION 3. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:
(1) THE ADDITION OF SECTION 635.8 OF THE ACT SHALL TAKE
EFFECT IN 30 DAYS.
(2) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT
IMMEDIATELY.
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