Mandated Benefits Review - Senate Bill 1183 - Review Process

The Pennsylvania Health Care Cost Containment Council's enabling legislation, Act 89 of 1986 (as reauthorized by Act 34 of 1993), provides that the Council review existing or proposed mandated health benefits when requested by the executive and legislative branches of government.

On March 31, 1998 Senator Edwin G. Holl, Chairman of the Senate Banking and Insurance Committee, requested that the Council review the provisions of Senate Bill 1183 (PN 1449 - Senator Greenleaf), which would mandate insurance coverage for the diagnosis and treatment of infertility. A copy of the bill is attached.

Notification was published in the Pennsylvania Bulletin on May 2, 1998 requesting that interested parties submit documentation pertaining to the bill to the Council by July 2, 1998. Letters also were sent to potentially interested individuals and organizations informing them of the pending review and inviting them to submit documentation pursuant to the notice. The Pennsylvania Department of Health and the Insurance Department were notified of the review and received copies of the submissions. Respondents were also given an opportunity to review the documentation received and submit a second round of documentation. A list of the documentation submitted to the Council is attached.

Act 34 also provides for a preliminary Council staff review of submitted materials to determine if documentation submitted is sufficient to proceed with the formal Mandated Benefits Review process outlined in the Act. This report presents the results of the Council's preliminary staff review and the conclusions of the Council regarding whether the material is sufficient to proceed with the formal review process.