PRINTER'S NO. 1037
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
877
Session of
2023
INTRODUCED BY KANE, TARTAGLIONE, DILLON, FONTANA AND COSTA,
AUGUST 16, 2023
REFERRED TO BANKING AND INSURANCE, AUGUST 16, 2023
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for disclosure of addiction treatment
coverage and for administrative penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 41
DISCLOSURE OF ADDICTION TREATMENT COVERAGE
Sec.
4101. Purpose of chapter.
4102. Definitions.
4103. Bi-annual notice.
4104. Administrative penalties.
4105. Applicability.
§ 4101. Purpose of chapter.
The purpose of this chapter is to require the complete and
proper disclosure and transparency of addiction services covered
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by policies issued to policy holders.
§ 4102. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
" Insurer. " As follows:
(1) An entity that issues or administers health
insurance policies or health plans and is subject to the
jurisdiction of the department.
(2) The term includes an entity organized or existing
under, or subject to, any of the following:
(i) The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) The act of May 18, 1976 (P.L.123, No.54),
known as the Individual Accident and Sickness Insurance
Minimum Standards Act.
(iv) Chapter 61 (relating to hospital plan
corporations) or 63 (relating to professional health
services plan corporations).
§ 4103. Bi-annual notice.
(a) Explanation of coverage.--The department shall direct
each insurer to provide members and insureds with a notice twice
per calendar year explaining the coverage for addiction
treatment services covered under the policy or plan.
(b) Requirement for notice.--A notice issued under this
chapter shall:
(1) Be no more than two pages.
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(2) Contain language that is nontechnical and readily
understandable.
(3) Explain the following:
(i) The coverage available for each level of
addiction treatment licensed by the Commonwealth,
including:
(A) Hospital and nonhospital detoxification.
(B) Hospital and nonhospital residential
rehabilitation, outpatient, partial hospitalization
and halfway houses.
(ii) Lengths of stay available for each level of
care under subparagraph (i).
(iii) The process to access covered services.
(iv) The process to file an appeal or a grievance.
(v) Avenues for accessing available public funding
if necessary.
(c) Review of notice.--Before an insurer provides a notice
under this chapter, the insurer shall submit the notice for
review for clarity, accuracy and approval to the Department of
Drug and Alcohol Programs. The Department of Drug and Alcohol
Programs shall convene representatives from the department,
Pennsylvania Recovery Organizations Alliance, the Drug and
Alcohol Service Providers Organization of Pennsylvania, parent
groups and others to review, approve or disapprove the notice.
(d) Approval of notice.--The department and the Department
of Drug and Alcohol Programs shall have 45 days to notify the
insurer, in writing, of approval of the language contained in
the notice under this section. The written approval shall be
sent via certified mail, electronic communication or other form
of communication that is agreed to by both the insurer and the
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departments and organizations under subsection (c).
(e) Disapproval and resolution.--The Department of Drug and
Alcohol Programs and the department shall jointly mediate and
assist in negotiating a resolution to any disputes over language
in the notification that cannot be resolved.
§ 4104. Administrative penalties.
The failure of an insurer to comply with section 4103
(relating to bi-annual notice) shall result in a fine or other
penalty as the department determines.
§ 4105. Applicability.
Section 303 of the act of December 18, 1996 (P.L.1066,
No.159), known as the Accident and Health Filing Reform Act,
shall not apply to a notice under this chapter.
Section 2. This act shall take effect immediately.
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