1Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2act relating to insurance; amending, revising, and
3consolidating the law providing for the incorporation of
4insurance companies, and the regulation, supervision, and
5protection of home and foreign insurance companies, Lloyds
6associations, reciprocal and inter-insurance exchanges, and
7fire insurance rating bureaus, and the regulation and
8supervision of insurance carried by such companies,
9associations, and exchanges, including insurance carried by
10the State Workmen's Insurance Fund; providing penalties; and
11repealing existing laws," providing for acquired brain injury
12disclosure.

13The General Assembly of the Commonwealth of Pennsylvania
14hereby enacts as follows:

15Section 1. The act of May 17, 1921 (P.L.682, No.284), known
16as The Insurance Company Law of 1921, is amended by adding a
17section to read:

18Section 635.7. Acquired Brain Injury Disclosure.--(a) Every
19insurer shall supply each insured and enrollee and each
20prospective insured and enrollee with the following written
21information upon request. The information shall be easily
22understandable by the layperson and shall include all of the
23following:

1(1) A description of coverage which includes the following:

2(i) Behavioral optometry or vision therapy.

3(ii) Case management.

4(iii) Cognitive communication therapy.

5(iv) Cognitive rehabilitation therapy.

6(v) Cognitive remediation.

7(vi) Community integration therapy.

8(vii) Family education and counseling.

9(viii) Hyperbaric oxygen therapy.

10(ix) Neurobehavioral testing.

11(x) Evaluation and treatment.

12(xi) Neurocognitive therapy and rehabilitation.

13(xii) Neuropsychological testing, evaluation and treatment.

14(xiii) Neuropsychiatric evaluation and treatment.

15(xiv) Neurofeedback therapy.

16(xv) Occupational therapy.

17(xvi) Physical therapy.

18(xvii) Post-acute transition services.

19(xviii) Speech and language therapy.

20(xix) Vision biofeedback.

21(2) A description of coverage, benefits and benefit maximums
22related to an acquired brain injury treatment and
23rehabilitation, including benefit limitations and exclusions of
24coverage, health care services and the definition of medical
25necessity used by the plan in determining whether these benefits
26will be covered.

27(3) A description of all necessary prior authorizations.

28(4) A description of an insurer's personnel responsible for
29case management and prior authorizations of an insured or
30enrollee with an acquired brain injury.

1(5) Other information as may be required by the department.

2(b) The department, in consultation with the Department of
3Health's Traumatic Brain Injury Advisory Board, shall promulgate
4regulations concerning the specific contents and wording of the
5notice required under this section.

6(c) For purposes of this section, the following words and
7phrases shall have the meanings given to them in this subsection
8unless the context clearly indicates otherwise:

9"Acquired brain injury" means the cognitive, intellectual,
10emotional, behavioral and physical effects of a traumatic or
11nontraumatic injury to the brain. The term does not include
12inherited, congenital or degenerative conditions.

13"Department" means the Insurance Department of the
14Commonwealth.

15"Health insurance policy" as follows:

16(1) Any group health, sickness or accident policy or
17subscriber contract or certificate issued by an entity subject
18to any of the following:

19(i) This act.

20(ii) The act of December 29, 1972 (P.L.1701, No.364), known
21as the "Health Maintenance Organization Act."

22(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
23corporations) or 63 (relating to professional health services
24plan corporations).

25(2) The term shall not include the following types of
26insurance or any combination of the following types of
27insurance:

28(i) Accident only.

29(ii) Fixed indemnity.

30(iii) Limited benefit.

1(iv) Credit.

2(v) Dental.

3(vi) Vision.

4(vii) Specified disease.

5(viii) Medicare supplement.

6(ix) CHAMPUS (Civilian Health and Medical Program of the
7Uniformed Services) supplement.

8(x) Long-term care or disability income.

9(xi) Workers' compensation.

10(xii) Automobile medical payment.

11"Insurer" means any entity that issues an individual or group
12health insurance policy, contract or plan described under the
13definition of health insurance policy.

14Section 2. This act shall take effect in 60 days.