Bill Text: PA HB1957 | 2011-2012 | Regular Session | Introduced

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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.

Spectrum: Strong Partisan Bill (Democrat 15-1)

Status: (Introduced - Dead) 2011-11-01 - Referred to INSURANCE [HB1957 Detail]

Download: Pennsylvania-2011-HB1957-Introduced.html

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PRINTER'S NO. 2688
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1957 Session of2011
INTRODUCED BY THOMAS, MYERS, BRIGGS, HARPER, WAGNER, PAYTON, GEORGE, COHEN, DALEY, CALTAGIRONE, PRESTON, PARKER, M. O'BRIEN, JOSEPHS AND YOUNGBLOOD, NOVEMBER 1, 2011
REFERRED TO COMMITTEE ON INSURANCE, NOVEMBER 1, 2011
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,
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.
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
sections to read:
Section 635.6. Pregnancy as a Preexisting Condition.--(a)
All health insurance policies that are offered, issued or
renewed on or after the effective date of this section may not
impose any preexisting condition exclusion that relates to, or
includes, a current or a prior pregnancy, complications
regarding a current or prior pregnancy or the performance of a
caesarean section for a prior pregnancy as a preexisting
condition.
(b) This section shall not apply to the following types of
policies:
(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.
(c) As used in this section:
(1) "Attending physician" means the attending obstetrician,
pediatrician or other physician attending the mother of a
newborn child.
(2) "Health care provider" means an attending physician,
nurse practitioner or certified nurse midwife.
(3) "Health insurance policy" means any individual or group
health or accident insurance policy or subscriber contract,
certificate or plan offered to, issued to or renewed on or after
the effective date of this section by an insurer which is
offered by or subject to any of the following:
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(i) This act.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 PaC.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(iv) Subarticle (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the "Public Welfare Code."
(v) The act of May 18, 1976 (P.L.123, No.54), known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(4) "Insurer" means any entity that issues a health
insurance policy, contract, certificate or plan described under
clause (2) of this subsection.
(5) "Preexisting condition" means a condition or disease for
which medical advice or treatment was recommended by or received
from a health care provider prior to the effective date of the
coverage.
Section 635.7. Coverage for Maternity Care.--(a) All health
insurance policies shall provide coverage for maternity care as
follows:
(1) Prenatal care, which shall include coverage for regular
health care visits and childbirth education in addition to
ongoing assessment of nutritional and other individual needs
consistent with nationally recognized standards and guidelines,
such as those promulgated by the Institute for Clinical Systems
Improvement (ICSI) or the American College of Obstetricians and
Gynecologists (ACOG).
(2) Childbirth and postdelivery care as follows:
(i) Childbirth care shall include at a minimum coverage for
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delivery and postdelivery inpatient care for:
(A) Forty-eight (48) hours of inpatient care for a mother
and her newborn child following a vaginal delivery.
(B) Ninety-six (96) hours of inpatient care for a mother and
her newborn child following a cesarean section.
(ii) Any decision to shorten the minimum coverage provided
shall be made by the health care provider in consultation with
the mother. A health insurance policy shall not provide any
compensation or other nonmedical remuneration to encourage a
mother and her newborn child to leave inpatient care before the
expiration of the minimum coverage specified in this section.
(iii) When discharge occurs prior to the times stated in
this subsection, coverage shall include at least one home health
care visit within forty-eight (48) hours after discharge by a
health care provider whose scope of practice includes postpartum
care.
(iv) Notwithstanding any other provision of this section, a
policy that provides coverage for delivery and postdelivery care
to a mother and her newborn child in the home shall not be
required to provide for a minimum of forty-eight (48) hours and
ninety-six (96) hours, respectively, of inpatient care unless
the inpatient care is determined to be medically necessary by
the health care provider consistent with nationally recognized
treatment standards and guidelines such as those promulgated by
ACOG or the American Academy of Pediatrics (AAP).
(3) Postpartum care, which shall be provided consistent with
nationally recognized standards and guidelines, such as those
promulgated by ACOG or AAP.
(b) Copayments, coinsurance and deductibles as follows:
(1) The coverage required under this section may be subject
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to any copayment, coinsurance or deductible amount in comparable
amounts to those imposed for similar care.
(2) Notwithstanding clause (1), the health insurance policy
shall not include any copayment, coinsurance or deductible
amount for any postdelivery home health care visits required
under subsection (a)(2).
(c) An insurer shall not refuse to contract with or
compensate for covered services an otherwise eligible health
care provider or nonparticipating health care provider solely
because the health care provider has in good faith communicated
with one or more of his current, former or prospective patients
regarding the provisions, terms or requirements of the insurer's
products as they relate to the needs of the health care
provider's patients.
(d) This section shall not apply to the following types of
policies:
(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.
(e) As used in this section:
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(1) "Attending physician" means the attending obstetrician,
pediatrician or other physician attending to a mother or her
newborn child.
(2) "Birth center" means a licensed facility that is not
part of a hospital that provides maternity care to mothers not
requiring hospitalization.
(3) "Health care facility" means a hospital, birth center or
health care provider's office.
(4) "Health care provider" means an attending physician,
nurse practitioner or certified nurse midwife.
(5) "Health insurance policy" means any individual or group
health or accident insurance policy or subscriber contract,
certificate or plan offered to, issued to or renewed on or after
the effective date of this section by an insurer that is offered
by or is subject to any 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).
(iv) Subarticle (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the "Public Welfare Code."
(v) The act of May 18, 1976 (P.L.123, No.54), known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(6) "Hospital" means a facility having an organized medical
staff and providing equipment and services primarily for
inpatient care to persons who require definitive diagnosis or
treatment, or both, for injury, illness, pregnancy or other
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disability.
(7) "Insurer" means an entity that issues individual or
group health insurance policy, contract or plan described under
clause (5) of this subsection.
(8) "Maternity care" means prenatal care, childbirth and
postdelivery care, and postpartum care provided at a health care
facility or at the home of a mother.
Section 2. Section 1005-A(c) of the act, added November 4,
1997 (P.L.492, No.51), is amended and the section is amended by
adding a subsection to read:
Section 1005-A. Policy Choice for Eligible Individuals.--
* * *
(c) [Nothing] Except as otherwise provided in subsection
(d), nothing in this article shall prohibit an eligible
individual from purchasing a policy which includes a preexisting
condition provision or is not otherwise offered under this
section from a designated insurer or any other insurer.
(d) (1) Notwithstanding any other provision of law to the
contrary, a policy offered, issued or renewed on or after the
effective date of this subsection by a designated insurer or any
other insurer shall not impose any preexisting condition
exclusion that relates to, or includes, a current or a prior
pregnancy, complications regarding a current or prior pregnancy
or the performance of a caesarean section for a prior pregnancy.
(2) For the purposes of this subsection, "preexisting
condition" shall have the meaning given in section 635.6.
Section 3. This act shall take effect in 60 days.
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