Bill Summary – FastDemocracy

PRINTER'S NO.     1010
                     THE GENERAL ASSEMBLY OF PENNSYLVANIA
                        SENATE BILL
                        No. 828
                                               Session of
                                                 2021
     INTRODUCED BY J. WARD, CAPPELLETTI, COLLETT, MENSCH AND
        BREWSTER, JULY 26, 2021
     REFERRED TO BANKING AND INSURANCE, JULY 26, 2021
                                    AN ACT
 Amending the act of July 22, 1974 (P.L.589, No.205), entitled
    "An act relating to unfair insurance practices; prohibiting
    unfair methods of competition and unfair or deceptive acts
    and practices; and prescribing remedies and penalties,"
    further providing for unfair methods of competition and
    unfair or deceptive acts or practices defined.
    The General Assembly of the Commonwealth of Pennsylvania
 hereby enacts as follows:
    Section 1.    Section 5(a) of the act of July 22, 1974
 (P.L.589, No.205), known as the Unfair Insurance Practices Act,
 is amended by adding a paragraph to read:
    Section 5.    Unfair Methods of Competition and Unfair or
 Deceptive Acts or Practices Defined.--(a)    "Unfair methods of
 competition" and "unfair or deceptive acts or practices" in the
 business of insurance means:
    * * *
    (15)    Altering the coverage provided by a health insurance
 policy, including, but not limited to, raising the premium,
 copayment, coinsurance or deductible or denying or otherwise
 failing to provide continued coverage for a health care benefit
 that was included in the insured's health insurance policy and
 when the insured has already received the health care benefit.
 The following shall apply:
    (i)     This paragraph shall not apply to health care benefits
 obtained by an insured through fraudulent or criminal activity
 or subject to:
    (A)     a statement issued by the United States Food and Drug
 Administration (FDA) calling into question the clinical safety
 of the benefit; or
    (B)     a notice provided by the manufacturer of a prescription
 drug to the FDA related to a manufacturing discontinuance or
 potential discontinuance of the drug.
    (ii)     In addition to any other penalties authorized by this
 act, a violation of this paragraph shall be deemed a violation
 of the act of December 17, 1968 (P.L.1224, No.387), known as the
 "Unfair Trade Practices and Consumer Protection Law." Nothing in
 this act shall preclude an insured from exercising any right
 provided under the "Unfair Trade Practices and Consumer
 Protection Law." A civil penalty of up to one thousand dollars
 ($1,000) shall be imposed on a health insurer who violates this
 paragraph.
    (iii)     As used in this paragraph:
    (A)     "Biological product" shall have the same meaning as
 "biological product" in the Public Health Service Act (58 Stat.
 682, 42 U.S.C. § 201 et seq.).
    (B)     "Health care benefits" means all products, services,
 procedures, treatments and prescription drugs for which coverage
 is provided under a health insurance policy offered by a health
 insurer.
    (C)     (I)   "Health insurance policy" means a group or
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 individual health or sickness or accident insurance policy,
 subscriber contract or certificate issued by an entity subject
 to any one of the following:
    (a)    The act of May 17, 1921 (P.L.682, No.284), known as "The
 Insurance Company Law of 1921," including section 630 and
 Article XXIV of that act.
    (b)    The act of December 29, 1972 (P.L.1701, No.364), known
 as the "Health Maintenance Organization Act."
    (c)    40 Pa.C.S. Ch. 61 (relating to hospital plan
 corporations) or 63 (relating to professional health services
 plan corporations).
    (II)    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.
    (D)    "Health insurer" means an entity licensed by the
 Insurance Department with accident and health authority to issue
 a policy, subscriber contract, certificate or plan that provides
 medical or health care coverage that is offered or governed
 under any of the following:
    (I)    "The Insurance Company Law of 1921," including section
 630 and Article XXIV of that act.
    (II)    The "Health Maintenance Organization Act."
    (III)    40 Pa.C.S. Ch. 61 or 63.
    (E)    "Insured" means a person who receives coverage under a
 health insurance policy and has paid all premiums due under the
 contract or policy. As used in this paragraph, the term shall
 include all individuals named in a health insurance policy
20210SB0828PN1010                   - 3 -
 issued by a health insurer.
    (F)    "Prescription drug" means a controlled substance, other
 drug, including a biological product, or device for medication
 dispensed by order of an appropriately licensed medical
 professional.
    (iv)    This paragraph shall not be interpreted to impact or
 inhibit the applicability of any provision of the act of
 November 24, 1976 (P.L.1163, No.259), referred to as the
 "Generic Equivalent Drug Law."
    (v)    Nothing in this paragraph shall be construed to prohibit
 a health insurer from adding health care benefits during the
 term of a health insurance policy.
    * * *
    Section 2.   This act shall take effect in 60 days.
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Statutes/Laws affected: 
Printer's No. 1010: P.L.589, No.205