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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY COX, BARRAR, BELFANTI, COHEN, CREIGHTON, DALEY, EVERETT, FABRIZIO, GINGRICH, GROVE, HUTCHINSON, MELIO, MOUL, PEIFER, PICKETT, ROAE, ROCK, ROHRER, STABACK, VULAKOVICH AND WANSACZ, FEBRUARY 6, 2009 |
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| REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 6, 2009 |
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| AN ACT |
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1 | Amending the act of July 22, 1974 (P.L.589, No.205), entitled |
2 | "An act relating to unfair insurance practices; prohibiting |
3 | unfair methods of competition and unfair or deceptive acts |
4 | and practices; and prescribing remedies and penalties," |
5 | further providing for definitions, for unfair acts and for |
6 | exclusions. |
7 | The General Assembly of the Commonwealth of Pennsylvania |
8 | hereby enacts as follows: |
9 | Section 1. Section 3 of the act of July 22, 1974 (P.L.589, |
10 | No.205), known as the Unfair Insurance Practices Act, amended |
11 | April 4, 1996 (P.L.100, No.24) and July 7, 2006 (P.L.363, No. |
12 | 78), is amended to read: |
13 | Section 3. Definitions.--As used in this act: |
14 | "Abuse" has the meaning given in 23 Pa.C.S. § 6102(a) |
15 | (relating to definitions), notwithstanding the limited |
16 | applicability provision in paragraph (5) of the definition of |
17 | "abuse" in 23 Pa.C.S. § 6102(a). The term also means attempting |
18 | to cause or intentionally, knowingly or recklessly causing |
19 | damage to property so as to intimidate or attempt to control the |
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1 | behavior of another person covered under 23 Pa.C.S. Ch. 61 |
2 | (relating to protection from abuse). |
3 | "Commissioner" means the Insurance Commissioner of the |
4 | Commonwealth of Pennsylvania. |
5 | "Family or household members" has the meaning given in 23 |
6 | Pa.C.S. § 6102(a) (relating to definitions). |
7 | "Insurance policy" or "insurance contract" means any contract |
8 | of insurance, indemnity, health care, suretyship, title |
9 | insurance, or annuity issued, proposed for issuance or intended |
10 | for issuance by any person. |
11 | "Person" means: |
12 | (1) any individual, corporation, association, partnership, |
13 | reciprocal exchange, inter-insurer, Lloyds insurer, fraternal |
14 | benefit society, beneficial association, agent, broker, adjuster |
15 | and any other legal entity engaged in the business of insurance; |
16 | [, including agents, brokers and adjusters and also means health |
17 | care plans as defined in 40 Pa.S. Ch.61 relating to hospital |
18 | plan corporations, 40 Pa.S. Ch.63 relating to professional |
19 | health services plan corporations, 40 Pa.S. Ch.65 relating to |
20 | fraternal and beneficial societies, 40 Pa.S. Ch.67 relating to |
21 | beneficial societies and the act of December 29, 1972 (P.L.1701, |
22 | No.364), known as the "Voluntary Nonprofit Health Service Act of |
23 | 1972."] |
24 | (2) a health care plan as defined in 40 Pa.C.S. Ch. 61 |
25 | (relating to hospital plan corporations), 40 Pa.C.S. Ch. 63 |
26 | (relating to professional health services plan corporations), 40 |
27 | Pa.C.S. Ch. 67 (relating to beneficial societies), Article XXIV |
28 | of the act of act of May 17, 1921 (P.L.682, No.284), known as |
29 | "The Insurance Company Law of 1921" and the act of December 29, |
30 | 1972 (P.L.1701, No.364), known as the "Health Maintenance |
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1 | Organization Act"; |
2 | (3) a self-insured or multiple employer welfare arrangement |
3 | not exempt from State regulation by the Employee Retirement |
4 | Income Security Act of 1974 (Public Law 93-406, 29 U.S.C. § 1001 |
5 | et seq.); and |
6 | (4) an employer-organized insurance association. |
7 | For purposes of this act, health care plans, fraternal benefit |
8 | societies and beneficial societies shall be deemed to be engaged |
9 | in the business of insurance. |
10 | "Renewal" or "to renew" means the issuance and delivery by an |
11 | insurer of a policy superseding at the end of the policy period |
12 | a policy previously issued and delivered by the same insurer, |
13 | such renewal policy to provide types and limits of coverage at |
14 | least equal to those contained in the policy being superseded, |
15 | or the issuance and delivery of a certificate or notice |
16 | extending the term of a policy beyond its policy period or term |
17 | with types and limits of coverage at least equal to those |
18 | contained in the policy being extended: Provided, however, That |
19 | any policy with a policy period or term of less than twelve |
20 | months or any period with no fixed expiration date shall for the |
21 | purpose of this act be considered as if written for successive |
22 | policy periods or terms of twelve months. |
23 | "Victim" means an individual who is or has been subjected to |
24 | abuse. |
25 | "Victim of abuse" means an individual who is a victim or an |
26 | individual who seeks or has sought medical or psychological |
27 | treatment for abuse, protection from abuse or shelter from |
28 | abuse. |
29 | Section 2. Section 5(a) of the act is amended by adding a |
30 | paragraph to read: |
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1 | Section 5. Unfair Methods of Competition and Unfair or |
2 | Deceptive Acts or Practices Defined.--(a) "Unfair methods of |
3 | competition" and "unfair or deceptive acts or practices" in the |
4 | business of insurance means: |
5 | * * * |
6 | (15) Knowingly doing any of the following: |
7 | (i) Requiring an insured to obtain drugs from a mail-order |
8 | pharmacy as a condition of obtaining the payment for the |
9 | prescription drugs. |
10 | (ii) Imposing upon an insured who is not utilizing a mail- |
11 | order pharmacy a copayment fee or other condition not imposed |
12 | upon insureds who utilize a mail-order pharmacy. |
13 | (iii) Denying or impairing the right of an insured to |
14 | determine from where drugs are dispensed. |
15 | * * * |
16 | Section 3. Section 14 of the act is amended to read: |
17 | Section 14. Exclusions.--Health care plans administered by |
18 | joint boards of trustees pursuant to section 302 of the Labor |
19 | Management Relations Act, 29 U.S.C. § 141, et seq., and employer |
20 | administered health care plans pursuant to collective bargaining |
21 | agreements which pay benefits from the assets of the trust or |
22 | the funds of the employer as opposed to payments through an |
23 | insurance company shall not be subject to any of the provisions |
24 | of this act except section 5(a)(15). |
25 | Section 4. The amendment or addition of sections 5(a)(15) |
26 | and 14 of the act shall apply to insurance policies issued or |
27 | renewed on or after the effective date of this section. |
28 | Section 5. This act shall take effect in 60 days. |
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