"In-network provider." A provider who contracts with an
insurer to provide health care services to an enrollee under a
health insurance policy.
"Insurer." An entity that offers, issues or renews an
individual or group health insurance policy that provides
medical or health care coverage by a health care facility or
licensed health care provider and that is governed under 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.
(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).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Out-of-network provider." A provider who does not contract
with an insurer to provide health care services to an enrollee
under a health insurance policy.
Section 3. Limitation on annual and lifetime limits.
(a) Generally.--Except as otherwise provided in this
section, an insurer offering, issuing or renewing an individual
or group health insurance policy may not establish, on either an
annual or lifetime basis, a limit on the dollar value of any
core benefit for an enrollee, whether provided by an in-network
or out-of-network provider.
(b) Core benefit.--For purposes of this section, a core
benefit shall include a benefit for which no annual or lifetime
per enrollee limit was permitted to be included in an individual
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