SB 66 — An Act providing for health insurance coverage requirements for stage four, advanced metastatic cancer.

PRIOR PRINTER'S NO.

38 PRINTER'STHE NO.GENERAL ASSEMBLY OF PENNSYLVANIA SENATE BILL Session of No.

926 THE GENERAL ASSEMBLY OF PENNSYLVANIA SENATE BILL Session of No.

WARD, PHILLIPS-HILL, COSTA, HUTCHINSON, COLLETT, TARTAGLIONE, SCHWANK, DINNIMAN, SANTARSIERO,SANTARSIERO LAUGHLIN, REGAN, BREWSTER AND KILLION,LAUGHLIN, JANUARY 14, 2019 SENATORREFERRED SCAVELLO,TO BANKING AND INSURANCE, ASJANUARY AMENDED,14, JUNE 10, 2019 AN ACT ProvidingProfour, foradvanced healthmetastatic insurancecancer.age coverage requirements for stage four,The advancedGeneral metastaticAssembly cancer.of the Commonwealth of Pennsylvania hereby enacts as follows:

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

"Enrollee." A policyholder, subscriber, covered person or other individual who is entitled to receive health care services under a health insurance planplan. POLICY.

<-- "Health insurance carrier." An entity that offers or issues a health insurance plan POLICY and is subject to any of the <-- following:

(1) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, INCLUDING SECTION 630 AND <-- ARTICLE XXIV OF THE INSURANCE COMPANY LAW OF 1921.

"Health insurance planplan." POLICY." A policy, contract, <-- certificate or agreement offered or issued,issued ISSUED OR RENEWED by <-- a health insurance carrier to provide for the costs of COVERAGE <-- FOR health care services.

(12)"Stage HOSPITALfour, INDEMNITY.advanced metastatic cancer." Cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes or other areas or parts of the body.

<-- (13) MEDICARE SUPPLEMENT.

"Stage four, advanced metastatic cancer." Cancer that has spread from the primary or original site of the cancer to nearby 20190SB0066PN0926 - 2 - tissues, lymph nodes or other areas or parts of the body.

A health insurance carrier or health insurance plan POLICY <-- that, directly or indirectly, covers the treatment of stage four, advanced metastatic cancer shall MAY not require an <-- enrollee to 20190SB0066PN0038 - 2 - first fail to successfully respond to a different drug, or prove a history of failure in use of a different drug, before providing coverage for a COVEREDdrug: drug TO WHICH BOTH OF <-- THE FOLLOWING APPLY:

(1) THE DRUG IS approved by the United States Food and <-- Drug Administration;

and (2) the use of which is consistent THE DRUG IS <-- CONSISTENT WITH ITS FDA-APPROVED INDICATION AND with the best CLINICAL practices for the treatment of stage four, advanced <-- metastatic cancer.

This act shall apply to insurance plans issued, delivered or <-- renewed on or after the effective date of this section.

ASSection <--5. FOLLOWS:

(1) FOR A HEALTH INSURANCE POLICY FOR WHICH EITHER RATES OR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT OR THE INSURANCE DEPARTMENT, THIS ACT SHALL APPLY TO ANY POLICY FOR WHICH A RATE OR FORM IS FIRST FILED ON OR AFTER 180 DAYS AFTER THE EFFECTIVE DATE OF THIS ACT.

(2) FOR A HEALTH INSURANCE POLICY FOR WHICH NEITHER RATES NOR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT OR THE INSURANCE DEPARTMENT, THIS ACT SHALL APPLY TO ANY POLICY ISSUED OR RENEWED ON OR AFTER 180 DAYS AFTER THE EFFECTIVE DATE OF THIS ACT.

20190SB0066PN0926 - 3 - Section 5.

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