SB 317 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for eating disorder treatment.

PRINTER'S NO.   251

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                        SENATE BILL
                        No. 317
                                               Session of
                                                 2025

     INTRODUCED BY KEARNEY, SANTARSIERO, HAYWOOD, FONTANA, KANE AND
        COSTA, FEBRUARY 26, 2025

     REFERRED TO BANKING AND INSURANCE, FEBRUARY 26, 2025


                                    AN ACT
 1   Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
 2      act relating to insurance; amending, revising, and
 3      consolidating the law providing for the incorporation of
 4      insurance companies, and the regulation, supervision, and
 5      protection of home and foreign insurance companies, Lloyds
 6      associations, reciprocal and inter-insurance exchanges, and
 7      fire insurance rating bureaus, and the regulation and
 8      supervision of insurance carried by such companies,
 9      associations, and exchanges, including insurance carried by
10      the State Workmen's Insurance Fund; providing penalties; and
11      repealing existing laws," in casualty insurance, providing
12      for coverage for eating disorder treatment.
13      The General Assembly of the Commonwealth of Pennsylvania
14   hereby enacts as follows:
15      Section 1.    The act of May 17, 1921 (P.L.682, No.284), known
16   as The Insurance Company Law of 1921, is amended by adding a
17   section to read:
18      Section 635.11.    Coverage for Eating Disorder Treatment.--(a)
19   All health insurance policies shall provide coverage for
20   treatment of eating disorders, which shall include inpatient
21   hospitalization, partial hospitalization, residential treatment,
22   intensive outpatient treatment, follow up outpatient care,
23   counseling, medical nutrition therapy and nutrition therapy
 1   services provided by a licensed treating physician,
 2   psychologist, psychiatrist, professional counselor, clinical
 3   social worker, marriage and family therapist or licensed
 4   dietitian-nutritionist in accordance with a treatment plan.
 5   Medical necessity determinations and care management for the
 6   treatment of eating disorders:
 7      (1)     shall consider the overall medical and mental health
 8   needs of the individual with an eating disorder;
 9      (2)     may not be based solely on weight; and
10      (3)     shall take into consideration the Diagnostic and
11   Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)for
12   the treatment of patients with eating disorders and the current
13   standards based upon the medical literature generally recognized
14   as authoritative in the medical community.
15      (b)     A health insurance policy and an insurer may not:
16      (1)     deny to an individual eligibility, or continued
17   eligibility, to enroll or to renew coverage under the terms of
18   the health insurance policy solely for the purpose of avoiding
19   the requirement of this section;
20      (2)     provide monetary payments, rebates or other benefits to
21   an individual to encourage the individual to accept less than
22   the minimum protections available under this section;
23      (3)     penalize or otherwise reduce or limit the reimbursement
24   of a provider because the provider provided care to an
25   individual participant or beneficiary in accordance with this
26   section;
27      (4)     provide incentives, monetary or otherwise, to a provider
28   to induce the provider to provide care to an individual
29   participant or beneficiary in a manner inconsistent with this
30   section; or

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 1      (5)    deny to an individual participant or beneficiary
 2   continued eligibility to enroll or to renew coverage under the
 3   terms of the policy solely because the individual was previously
 4   found to have an eating disorder or to have received treatment
 5   for an eating disorder.
 6      (c)    Nothing in this section may be construed as preventing a
 7   health insurance policy from imposing deductibles, coinsurance
 8   or other cost-sharing in relation to treatment for eating
 9   disorders, except that the deductibles, coinsurance or other
10   cost-sharing may not be greater than the deductibles,
11   coinsurance or other cost-sharing imposed on other comparable
12   coverages for medical or surgical services under the policy.
13      (d)    The following words and phrases shall have the meanings
14   given to them in this subsection unless the context clearly
15   indicates otherwise:
16      "Clinical social worker."     A licensed clinical social worker
17   as defined in section 3 of the act of July 9, 1987 (P.L.220,
18   No.39), known as the "Social Workers, Marriage and Family
19   Therapists and Professional Counselors Act."
20      "Eating disorder."     Anorexia nervosa, bulimia nervosa,
21   avoidant/restrictive food intake disorder, binge-eating
22   disorder, pica, rumination disorder and other specified feeding
23   or eating disorders.
24      "Health insurance policy."     As follows:
25      (1)    An individual or group health, sickness or accident
26   policy, subscriber contract or certificate offered, issued or
27   renewed by an entity subject to one of the following:
28      (i)    This act.
29      (ii)    The act of December 29, 1972 (P.L.1701, No.364), known
30   as the "Health Maintenance Organization Act."

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 1      (iii)    40 Pa.C.S. Ch. 61 (relating to hospital plan
 2   corporations) or 63 (relating to professional health services
 3   plan corporations).
 4      (2)   The term does not include accident only, fixed
 5   indemnity, limited benefit, credit, dental, vision, specified
 6   disease, Medicare supplement, Civilian Health and Medical
 7   Program of the Uniformed Services (CHAMPUS) supplement, long-
 8   term care or disability income, workers' compensation or
 9   automobile medical payment insurance.
10      "Individual health insurance policy."       A policy, subscriber
11   contract, certificate or plan issued by an insurer that provides
12   medical or health care coverage on an annual basis to an
13   individual other than in connection with a group insurance plan.
14      "Insurer."    An entity offering a health insurance policy.
15      "Licensed dietitian-nutritionist."       As defined in section 2
16   of the act of May 22, 1951 (P.L.317, No.69), known as "The
17   Professional Nursing Law."
18      "Marriage and family therapist."       A licensed marriage and
19   family therapist as defined in section 3 of the "Social Workers,
20   Marriage and Family Therapists and Professional Counselors Act."
21      "Medical nutrition therapy."    As defined in section 2 of "The
22   Professional Nursing Law."
23      "Nutrition therapy services."       As defined in section 2 of
24   "The Professional Nursing Law."
25      "Physician."    As defined in section 2 of the act of December
26   20, 1985 (P.L.457, No.112), known as the "Medical Practice Act
27   of 1985."
28      "Professional counselor."    A licensed professional counselor
29   as defined in section 3 of the "Social Workers, Marriage and
30   Family Therapists and Professional Counselors Act."

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 1      "Psychiatrist."   As defined in section 102 of the act of
 2   October 20, 1966 (3rd Sp.Sess., P.L.96, No.6), known as the
 3   "Mental Health and Intellectual Disability Act of 1966."
 4      "Psychologist."   A person licensed to practice psychology
 5   under the act of March 23, 1972 (P.L.136, No.52), known as the
 6   "Professional Psychologists Practice Act."
 7      Section 2.   The addition of section 635.11 of the act applies
 8   as follows:
 9          (1)    For health insurance policies for which either rates
10      or forms are required to be filed with the Insurance
11      Department or the Federal Government, section 635.11 of the
12      act shall apply to any such policy for which a form or rate
13      is first filed on or after the effective date of this
14      section.
15          (2)    For health insurance policies for which neither
16      rates nor forms are required to be filed with the Insurance
17      Department or the Federal Government, section 635.11 of the
18      act shall apply to any such policy issued or renewed on or
19      after 180 days after the effective date of this section.
20      Section 3.   This act shall take effect in 60 days.




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