PRINTER'S NO. 140
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
184
Session of
2019
INTRODUCED BY LEACH, FARNESE, COSTA, SCHWANK, SANTARSIERO AND
HAYWOOD, FEBRUARY 1, 2019
REFERRED TO BANKING AND INSURANCE, FEBRUARY 1, 2019
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 casualty insurance, providing
for coverage for eating disorder treatment.
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 to read:
Section 635.8. Coverage for Eating Disorder Treatment.--(a)
All health insurance policies as defined in this section shall
provide coverage for treatment of eating disorders, including
coverage for residential treatment of eating disorders, if the
treatment is medically necessary in accordance with the practice
guidelines for the treatment of patients with eating disorders,
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as most recently published by the American Psychiatric
Association.
(b) A health insurance policy and an insurer shall not:
(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the health insurance policy solely for the purpose of avoiding
the requirement of this section;
(2) provide monetary payments, rebates or other benefits to
an individual to encourage the individual to accept less than
the minimum protections available under this section;
(3) penalize or otherwise reduce or limit the reimbursement
of a provider because the provider provided care to an
individual participant or beneficiary in accordance with this
section;
(4) provide incentives, monetary or otherwise, to a provider
to induce the provider to provide care to an individual
participant or beneficiary in a manner inconsistent with this
section; or
(5) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the policy solely because the individual was previously
found to have an eating disorder or to have received treatment
for an eating disorder.
(c) Nothing in this section may be construed as preventing a
health insurance policy from imposing deductibles, coinsurance
or other cost-sharing in relation to treatment for eating
disorders, except that the deductibles, coinsurance or other
cost-sharing shall not be greater than the deductibles,
coinsurance or other cost-sharing imposed on other comparable
medical or surgical services covered under the policy.
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(d) For the purpose of this section:
(1) "Eating disorder" means anorexia nervosa, bulimia
nervosa and eating disorders not otherwise specified, including
binge eating disorder, as defined in the most recent edition of
Diagnostic and Statistical Manual of Mental Disorders.
(2) "Health insurance policy" means any group health,
sickness or accident policy or subscriber contract or
certificate offered to groups of fifty-one (51) or more employes
issued by an entity subject to any one of the following:
(i) This act.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 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.
(3) "Insurer" means any entity offering a health insurance
policy as defined in this section.
Section 2. This act shall take effect in 60 days.
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