Bill Text: PA SB1063 | 2011-2012 | Regular Session | Introduced


Bill Title: In health and accident insurance, providing for pregnancy as a preexisting condition and for coverage for maternity care; and, in health care insurance individual accessibility, further providing for policy choice for eligible individuals.

Status: (Introduced - Dead) 2011-05-16 - Referred to BANKING AND INSURANCE [SB1063 Detail]

Download: Pennsylvania-2011-SB1063-Introduced.html

  

 

    

PRINTER'S NO.  1234

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

SENATE BILL

 

No.

1063

Session of

2011

  

  

INTRODUCED BY FARNESE, RAFFERTY, FONTANA, SOLOBAY, BOSCOLA, COSTA, STACK, WILLIAMS, TARTAGLIONE, WASHINGTON, KITCHEN, LEACH AND SCHWANK, MAY 16, 2011

  

  

REFERRED TO BANKING AND INSURANCE, MAY 16, 2011  

  

  

  

AN ACT

  

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Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An

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act relating to insurance; amending, revising, and

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consolidating the law providing for the incorporation of

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insurance companies, and the regulation, supervision, and

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protection of home and foreign insurance companies, Lloyds

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associations, reciprocal and inter-insurance exchanges, and

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fire insurance rating bureaus, and the regulation and

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supervision of insurance carried by such companies,

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associations, and exchanges, including insurance carried by

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the State Workmen's Insurance Fund; providing penalties; and

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repealing existing laws," in health and accident insurance,

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providing for pregnancy as a preexisting condition and for

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coverage for maternity care; and, in health care insurance

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individual accessibility, further providing for policy choice

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for eligible individuals.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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Section 1.  The act of May 17, 1921 (P.L.682, No.284), known

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as The Insurance Company Law of 1921, is amended by adding

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sections to read:

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Section 635.6.  Pregnancy as a Preexisting Condition.--(a)

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All health insurance policies that are offered, issued or

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renewed on or after the effective date of this section may not

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impose any preexisting condition exclusion that relates to, or

 


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includes, a current or a prior pregnancy, complications

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regarding a current or prior pregnancy or the performance of a

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caesarean section for a prior pregnancy as a preexisting

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condition.

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(b)  This section shall not apply to the following types of

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policies:

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(1)    Accident only.

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(2)  Fixed indemnity.

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(3)  Limited benefit.

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(4)  Credit.

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(5)  Dental.

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(6)    Vision.

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(7)  Specified disease.

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(8)  Medicare supplement.

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(9)    Civilian Health and Medical Program of the Uniformed

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Services (CHAMPUS) supplement.

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(10)  Long-term care or disability income.

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(11)  Workers' compensation.

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(12)  Automobile medical payment.

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(c)    As used in this section:

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(1)    "Attending physician" means the attending obstetrician,

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pediatrician or other physician attending the mother of a

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newborn child.

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(2)    "Health care provider" means an attending physician,

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nurse practitioner or certified nurse midwife.

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(3)  "Health insurance policy" means any individual or group

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health or accident insurance policy or subscriber contract,

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certificate or plan offered to, issued to or renewed on or after

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the effective date of this section by an insurer which is

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offered by or subject to any of the following:

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(i)    This act.

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

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as the "Health Maintenance Organization Act."

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(iii)  40 PaC.S. Ch. 61 (relating to hospital plan

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corporations) or 63 (relating to professional health services

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plan corporations).

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(iv)  Subarticle (f) of Article IV of the act of June 13,

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1967 (P.L.31, No.21), known as the "Public Welfare Code."

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(v)    The act of May 18, 1976 (P.L.123, No.54), known as the

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"Individual Accident and Sickness Insurance Minimum Standards

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Act."

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(4)    "Insurer" means any entity that issues a health

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insurance policy, contract, certificate or plan described under

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clause (2) of this subsection.

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(5)  "Preexisting condition" means a condition or disease for

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which medical advice or treatment was recommended by or received

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from a health care provider prior to the effective date of the

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coverage.

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Section 635.7.  Coverage for Maternity Care.--(a)  All health

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insurance policies shall provide coverage for maternity care as

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follows:

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(1)  Prenatal care, which shall include coverage for regular

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health care visits and childbirth education in addition to

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ongoing assessment of nutritional and other individual needs

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consistent with nationally recognized standards and guidelines,

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such as those promulgated by the Institute for Clinical Systems

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Improvement (ICSI) or the American College of Obstetricians and

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Gynecologists (ACOG).

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(2)  Childbirth and postdelivery care as follows:

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(i)  Childbirth care shall include at a minimum coverage for

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delivery and postdelivery inpatient care for:

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(A)  Forty-eight (48) hours of inpatient care for a mother

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and her newborn child following a vaginal delivery.

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(B)  Ninety-six (96) hours of inpatient care for a mother and

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her newborn child following a cesarean section.

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(ii)  Any decision to shorten the minimum coverage provided

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shall be made by the health care provider in consultation with

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the mother. A health insurance policy shall not provide any

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compensation or other nonmedical remuneration to encourage a

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mother and her newborn child to leave inpatient care before the

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expiration of the minimum coverage specified in this section.

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(iii)  When discharge occurs prior to the times stated in

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this subsection, coverage shall include at least one home health

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care visit within forty-eight (48) hours after discharge by a

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health care provider whose scope of practice includes postpartum

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care.

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(iv)  Notwithstanding any other provision of this section, a

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policy that provides coverage for delivery and postdelivery care

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to a mother and her newborn child in the home shall not be

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required to provide for a minimum of forty-eight (48) hours and

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ninety-six (96) hours, respectively, of inpatient care unless

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the inpatient care is determined to be medically necessary by

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the health care provider consistent with nationally recognized

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treatment standards and guidelines such as those promulgated by

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ACOG or the American Academy of Pediatrics (AAP).

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(3)  Postpartum care, which shall be provided consistent with

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nationally recognized standards and guidelines, such as those

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promulgated by ACOG or AAP.

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(b)  Copayments, coinsurance and deductibles as follows:

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(1)  The coverage required under this section may be subject

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to any copayment, coinsurance or deductible amount in comparable

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amounts to those imposed for similar care.

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(2)  Notwithstanding clause (1), the health insurance policy

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shall not include any copayment, coinsurance or deductible

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amount for any postdelivery home health care visits required

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under subsection (a)(2).

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(c)  An insurer shall not refuse to contract with or

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compensate for covered services an otherwise eligible health

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care provider or nonparticipating health care provider solely

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because the health care provider has in good faith communicated

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with one or more of his current, former or prospective patients

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regarding the provisions, terms or requirements of the insurer's

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products as they relate to the needs of the health care

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provider's patients.

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(d)  This section shall not apply to the following types of

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policies:

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(1)  Accident only.

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(2)  Fixed indemnity.

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(3)  Limited benefit.

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(4)  Credit.

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(5)  Dental.

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(6)  Vision.

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(7)  Specified disease.

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(8)  Medicare supplement.

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(9)  Civilian Health and Medical Program of the Uniformed

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Services (CHAMPUS) supplement.

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(10)  Long-term care or disability income.

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(11)  Workers' compensation.

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(12)  Automobile medical payment.

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(e)  As used in this section:

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(1)  "Attending physician" means the attending obstetrician,

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pediatrician or other physician attending to a mother or her

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newborn child.

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(2)  "Birth center" means a licensed facility that is not

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part of a hospital that provides maternity care to mothers not

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requiring hospitalization.

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(3)  "Health care facility" means a hospital, birth center or

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health care provider's office.

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(4)  "Health care provider" means an attending physician,

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nurse practitioner or certified nurse midwife.

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(5)  "Health insurance policy" means any individual or group

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health or accident insurance policy or subscriber contract,

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certificate or plan offered to, issued to or renewed on or after

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the effective date of this section by an insurer that is offered

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by or is subject to any of the following:

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(i)  This act.

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

18

as the "Health Maintenance Organization Act."

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(iii)  40 Pa.C.S. Ch. 61 (relating to hospital plan

20

corporations) or 63 (relating to professional health services

21

plan corporations).

22

(iv)  Subarticle (f) of Article IV of the act of June 13,

23

1967 (P.L.31, No.21), known as the "Public Welfare Code."

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(v)  The act of May 18, 1976 (P.L.123, No.54), known as the

25

"Individual Accident and Sickness Insurance Minimum Standards

26

Act."

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(6)  "Hospital" means a facility having an organized medical

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staff and providing equipment and services primarily for

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inpatient care to persons who require definitive diagnosis or

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treatment, or both, for injury, illness, pregnancy or other

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disability.

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(7)  "Insurer" means an entity that issues individual or

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group health insurance policy, contract or plan described under

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clause (5) of this subsection.

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(8)  "Maternity care" means prenatal care, childbirth and

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postdelivery care, and postpartum care provided at a health care

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facility or at the home of a mother.

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Section 2.  Section 1005-A(c) of the act, added November 4,

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1997 (P.L.492, No.51), is amended and the section is amended by

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adding a subsection to read:

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Section 1005-A.  Policy Choice for Eligible Individuals.--

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* * *

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(c)  [Nothing] Except as otherwise provided in subsection

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(d), nothing in this article shall prohibit an eligible

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individual from purchasing a policy which includes a preexisting

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condition provision or is not otherwise offered under this

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section from a designated insurer or any other insurer.

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(d)  (1)  Notwithstanding any other provision of law to the

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contrary, a policy offered, issued or renewed on or after the

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effective date of this subsection by a designated insurer or any

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other insurer shall not impose any preexisting condition

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exclusion that relates to, or includes, a current or a prior

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pregnancy, complications regarding a current or prior pregnancy

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or the performance of a caesarean section for a prior pregnancy.

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(2)  For the purposes of this subsection, "preexisting

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condition" shall have the meaning given in section 635.6.

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Section 3.  This act shall take effect in 60 days.

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