Bill Text: PA HB2272 | 2009-2010 | Regular Session | Introduced

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Bill Title: Further defining "health insurance policy"; and providing for nonallergenic baby formula.

Spectrum: Slight Partisan Bill (Democrat 16-6)

Status: (Introduced - Dead) 2010-03-01 - Referred to INSURANCE [HB2272 Detail]

Download: Pennsylvania-2009-HB2272-Introduced.html

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PRINTER'S NO. 3245
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2272 Session of2010
INTRODUCED BY BRADFORD, SONNEY, BRENNAN, BRIGGS, FABRIZIO, GOODMAN, HORNAMAN, KORTZ, MANN, McGEEHAN, PARKER, PYLE, SIPTROTH, STABACK, TRUE, VULAKOVICH AND WAGNER, MARCH 1, 2010
REFERRED TO COMMITTEE ON INSURANCE, MARCH 1, 2010
AN ACT
Amending the act of December 20, 1996 (P.L.1492, No.191),
entitled "An act providing for certain health insurance
policies to cover the cost of formulas necessary for the
treatment of phenylketonuria and related disorders," further
defining "health insurance policy"; and providing for
nonallergenic baby formula.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Sections 2, 3, 4, 6 and 7 of the act of December
20, 1996 (P.L.1492, No.191), known as the Medical Foods
Insurance Coverage Act, are amended to read:
Section 2. Declaration of policy.
The General Assembly finds and declares as follows:
(1) Phenylketonuria (PKU), branched-chain ketonuria,
galactosemia and homocystinuria are aminoacidopathies that
are rare hereditary genetic metabolic disorders.
(2) Lacking in these aminoacidopathies is the body's
ability to process or metabolize amino acids, and, if left
untreated or without proper therapeutic management, these
disorders cause severe mental retardation and chronic
physical disabilities.
(3) The only form of treatment is by restricting food
intake in order to remove the problem amino acids, which are
necessary in the diet, and then replenishing them in
carefully controlled measured amounts of a nutritional food
substitute.
(4) In an attempt to encourage the development of new
products, increase availability and reduce cost, formulas
were removed from the Federal prescription list and
reclassified as medical foods. An unfortunate side effect has
been the reluctance of many insurance companies to cover the
cost of these formulas. In instances where coverage is
provided, it is random and subject to inconsistent
interpretation.
(5) The intent of this legislation is not to require
insurance coverage for normal food products used in dietary
management of these disorders, but to provide for such
coverage of formulas that are equivalent to a prescription
drug and nonallergenic baby formula medically necessary for
the therapeutic treatment of such rare hereditary genetic
metabolic disorders and administered under the direction of a
physician.
(6) In recognition by the General Assembly that such
formulas and nonallergenic baby formula are medically
necessary and critical to the well-being of individuals
afflicted with rare hereditary genetic metabolic disorders,
it shall be required that health insurance policies issued in
this Commonwealth shall include such coverage.
Section 3. Definitions.
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The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Health insurance policy." Except for specified disease and
accident-only policies, the term shall mean any group health
insurance policy, contract or plan or any individual policy,
contract or plan [with coverage for prescription drugs] which
provides medical coverage on an expense-incurred, service or
prepaid basis. The term includes the following:
(1) A health insurance policy or contract issued by a
nonprofit corporation subject to 40 Pa.C.S. Chs. 61 (relating
to hospital plan corporations) and 63 (relating to
professional health services plan corporations) and [the act
of December 14, 1992 (P.L.835, No.134), known as the
Fraternal Benefit Societies Code.] Article 24 of the act of
May 17, 1921 (P.L.582, No.284), known as The Insurance
Company Law of 1921.
(2) A health service plan operating under the act of
December 29, 1972 (P.L.1701, No.364), known as the Health
Maintenance Organization Act.
Section 4. Medical foods insurance coverage.
Except as provided in section 7, any health insurance policy
which is delivered, issued for delivery, renewed, extended or
modified in this Commonwealth by any health care insurer shall
provide that the health insurance benefits applicable under the
policy include coverage for the cost of nutritional supplements
(formulas) and nonallergenic baby formula as medically necessary
for the therapeutic treatment of phenylketonuria, branched-chain
ketonuria, galactosemia and homocystinuria as administered under
the direction of a physician.
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Section 6. Cost-sharing provisions.
(a) Applicability.--Benefits for nutritional supplements
(formulas) and nonallergenic baby formula as medically necessary
for the therapeutic treatment of phenylketonuria, branched-chain
ketonuria, galactosemia and homocystinuria as administered under
the direction of a physician shall be subject to copayment and
coinsurance provisions of a health insurance policy to the
extent that other medical services covered by the policy are
subject to those provisions.
(b) Exemption.--Benefits for nutritional supplements
(formulas) and nonallergenic baby formula as medically necessary
for the therapeutic treatment of phenylketonuria, branched-chain
ketonuria, galactosemia and homocystinuria as administered under
the direction of a physician shall be exempt from deductible
provisions in a health insurance policy. This exemption must be
explicitly provided for in the policy.
Section 7. Exemption.
Notwithstanding sections 4 and 5, this act shall not be
construed to require a health insurance policy to include
coverage for nutritional supplements (formulas) and
nonallergenic baby formula as medically necessary for the
therapeutic treatment of phenylketonuria, branched-chain
ketonuria, galactosemia and homocystinuria as administered under
the direction of a physician for an individual who is a resident
of this Commonwealth if all of the following apply:
(1) The individual is employed outside this
Commonwealth.
(2) The individual's employer maintains a health
insurance policy for the individual as an employment benefit.
Section 2. This act shall take effect in 180 days.
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