2022 Pennsylvania Consolidated & Unconsolidated Statutes
Act 162 - INSURANCE COMPANY LAW OF 1921 - COVERAGE FOR REFILL OF PRESCRIPTION EYE DROPS

Session of 2022

No. 2022-162

SB 1201

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 coverage for refill of prescription eye drops.

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 635.8.  Coverage for Refill of Prescription Eye Drops.--(a)  A health insurance policy offered, issued or renewed in this Commonwealth shall provide coverage for a prescription eye drops refill if the refill:

(1)  Is requested:

(i)  For a thirty-day supply, between twenty-one and thirty days of the later of:

(A)  the original date the prescription was distributed to the insured; or

(B)  the date the most recent refill was distributed to the insured.

(ii)  For a sixty-day supply, between forty-two and sixty days from the later of:

(A)  the original date the prescription was distributed to the insured; or

(B)  the date the most recent refill was distributed to the insured.

(iii)  For a ninety-day supply, between sixty-three and ninety days from the later of:

(A)  the original date the prescription was distributed to the insured; or

(B)  the date the most recent refill was distributed to the insured.

(2)  Is prescribed by a health care practitioner and is a covered benefit under the health insurance policy of the insured.

(3)  Does not exceed the total number of refills indicated on the original prescription.

(b)  As used in this section:

"Health insurance policy" means an individual or group insurance policy, subscriber contract, certificate or plan issued by an insurer that provides medical or health care coverage, including emergency services. The term does not include:

(1)  An accident only policy.

(2)  A credit only policy.

(3)  A long-term care or disability income policy.

(4)  A specified disease policy.

(5)  A Medicare supplement policy.

(6)  A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy.

(7)  A fixed indemnity policy.

(8)  A hospital indemnity policy.

(9)  A dental only policy.

(10)  A vision only policy.

(11)  A workers' compensation policy.

(12)  An automobile medical payment policy.

(13)  A homeowners' insurance policy.

(14)  A short-term limited duration policy.

(15)  Any other similar policy providing for limited benefits.

"Insurer" means an entity licensed by the department with accident and health authority to issue a health insurance policy that is offered or governed under any of the following:

(1)  This act, including section 630 and Article XXIV.

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

(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations).

Section 2.  The addition of section 635.8 of the act shall apply to the following:

(1)  For a health insurance policy for which either rates or forms are required to be filed with the Insurance Department or the Federal Government, a policy for which a form or rate is first filed on or after the effective date of this section.

(2)  For a health insurance policy for which rates or forms are not required to be filed with the Insurance Department or the Federal Government, a policy issued or renewed on or after 180 days from the effective date of this section.

(3)  A contract between a health care practitioner and an insurer that is executed or renewed on or after 180 days from the effective date of this section.

Section 3.  This act shall take effect in 60 days.

APPROVED--The 3rd day of November, A.D. 2022.

TOM WOLF