PRINTER'S NO. 1232
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
976
Session of
2015
INTRODUCED BY MURT, V. BROWN, COHEN, DAVIDSON, HARPER, MAJOR,
McCARTER, PICKETT, SCHWEYER AND WATSON, APRIL 15, 2015
REFERRED TO COMMITTEE ON INSURANCE, APRIL 15, 2015
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 casualty insurance, providing
for acquired brain injury disclosure.
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 a
section to read:
Section 635.7. Acquired Brain Injury Disclosure.--(a) An
insurer shall supply each insured and enrollee and each
prospective insured and enrollee with the following written
information upon request. The information shall be easily
understandable by the layperson and shall include all of the
following:
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(1) A description of coverage which includes the following:
(i) Behavioral optometry or vision therapy.
(ii) Case management.
(iii) Cognitive communication therapy.
(iv) Cognitive rehabilitation therapy.
(v) Cognitive remediation.
(vi) Community integration therapy.
(vii) Family education and counseling.
(viii) Hyperbaric oxygen therapy.
(ix) Neurobehavioral testing.
(x) Evaluation and treatment.
(xi) Neurocognitive therapy and rehabilitation.
(xii) Neuropsychological testing, evaluation and treatment.
(xiii) Neuropsychiatric evaluation and treatment.
(xiv) Neurofeedback therapy.
(xv) Occupational therapy.
(xvi) Physical therapy.
(xvii) Post-acute transition services.
(xviii) Speech and language therapy.
(xix) Vision biofeedback.
(2) A description of coverage, benefits and benefit maximums
related to an acquired brain injury treatment and
rehabilitation, including benefit limitations and exclusions of
coverage, health care services and the definition of medical
necessity used by the plan in determining whether these benefits
will be covered.
(3) A description of all necessary prior authorizations.
(4) A description of an insurer's personnel responsible for
case management and prior authorizations of an insured or
enrollee with an acquired brain injury.
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(5) Other information as may be required by the department.
(b) The department, in consultation with the Department of
Health's Traumatic Brain Injury Advisory Board, shall promulgate
regulations concerning the specific contents and wording of the
notice required under this section.
(c) For purposes of this section, the following words and
phrases shall have the meanings given to them in this subsection
unless the context clearly indicates otherwise:
"Acquired brain injury" means the cognitive, intellectual,
emotional, behavioral and physical effects of a traumatic or
nontraumatic injury to the brain. The term does not include
inherited, congenital or degenerative conditions.
"Department" means the Insurance Department of the
Commonwealth.
"Health insurance policy" means as follows:
(1) Any group health, sickness or accident policy or
subscriber contract or certificate issued by an entity 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).
(2) The term does not include the following types of
insurance or any combination of the following types of
insurance:
(i) Accident only.
(ii) Fixed indemnity.
(iii) Limited benefit.
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(iv) Credit.
(v) Dental.
(vi) Vision.
(vii) Specified disease.
(viii) Medicare supplement.
(ix) CHAMPUS (Civilian Health and Medical Program of the
Uniformed Services) supplement.
(x) Long-term care or disability income.
(xi) Workers' compensation.
(xii) Automobile medical payment.
"Insurer" means any entity that issues an individual or group
health insurance policy, contract or plan described under the
definition of health insurance policy.
Section 2. This act shall take effect in 60 days.
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