Pennsylvania Act 1992-35 — CHILDHOOD IMMUNIZATION INSURANCE ACT

Act text

CHILDHOOD IMMUNIZATION INSURANCE ACT
                  Act of May 21, 1992, P.L. 239, No. 35               Cl. 40
                                  AN ACT

     Providing for health insurance coverage of children; and
        conferring powers and duties on the Department of Health and
        the Insurance Department.

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

     Section 1.  Short title.
        This act shall be known and may be cited as the Childhood
     Immunization Insurance Act.
     Section 2.  Definitions.
        The following words and phrases when used in this act shall
     have the meanings given to them in this section unless the
     context clearly indicates otherwise:
        "Child immunizations."  Immunizations, including the
     immunizing agent, reimbursement for which shall not exceed 150%
     of the average wholesale price, which, as determined by the
     Department of Health, conform with the standards of the Advisory
     Committee on Immunization Practices of the Center for Disease
     Control, the United States Department of Health and Human
     Services.
        "Health insurance policy."  Except for specified disease
     policies, shall mean any group health insurance policy, contract
     or plan, or any individual policy, contract or plan with
     dependent coverage for children, which provides medical coverage
     on an expense-incurred, service or prepaid basis. The term
     includes the following:
            (1)  A health insurance policy or contract issued by a
        nonprofit corporation subject to 40 Pa.C.S. Chs. 61 (relating
        to hospital plan corporations), 63 (relating to professional
        health services plan corporations) and 65 (relating to
        fraternal benefit societies).
            (2)  A health service plan operating under the act of
        December 29, 1972 (P.L.1701, No.364), known as the Health
        Maintenance Organization Act.
            (3)  An employee welfare benefit plan as defined in
        section 3 of the Employee Retirement Income Security Act of
        1974 (Public Law 93-406, 29 U.S.C. § 1001 et seq.).
     Section 3.  Child immunizations.
        Except as provided in section 6, any health insurance policy
     which is delivered, issued for delivery, renewed, extended or
     modified in this Commonwealth by any health care insurer shall
     provide that the health insurance benefits applicable under the
     policy include coverage for child immunizations. A health
     insurance policy shall provide for coverage for medically
     necessary booster doses of all immunizing agents used in child
     immunizations.
     Section 4.  Delivery of policy.
        Except as provided in section 6, if a health insurance policy
     provides coverage or benefits to a resident of this
     Commonwealth, it shall be deemed to be delivered in this
     Commonwealth within the meaning of this act, regardless of
     whether the health care insurer issuing or delivering said
     policy is located within or outside this Commonwealth.
     Section 5.  Cost-sharing provisions.
        (a)  Applicability.--Benefits for child immunization services
     shall be subject to copayment and coinsurance provisions of a
     health insurance policy to the extent that other medical
     services covered by the policy are subject to those provisions.
        (b)  Exemption.--Benefits for child immunization services
     shall be exempt from deductible or dollar limit provisions in a
     health insurance policy. This exemption must be explicitly
     provided for in the policy.
     Section 6.  Exemption.
        Notwithstanding sections 3 and 4, this act shall not be
     construed to require a health insurance policy to include
     coverage for child immunizations for an individual who is a
     resident of this Commonwealth if all of the following apply:
            (1)  The individual is employed outside this
        Commonwealth.
            (2)  The individual's employer maintains a health
        insurance policy for the individual as an employment benefit.
     Section 7.  Regulations.
        The Department of Health and the Insurance Department shall
     promulgate regulations to implement this act.
     Section 8.  Application of act.
        This act shall apply to all insurance policies, subscriber
     contracts and group insurance certificates issued under any
     group master policy, delivered or issued for delivery on or
     after the effective date of this act. This act shall also apply
     to all renewals of contracts on any renewal date which is on or
     after the effective date of this act.
     Section 9.  Effective date.
        This act shall take effect in six months.