§ 89.806. Coverage of child immunizations.
(a) Policy coverage.
(1) A health insurance policy which is not exempt from this subchapter under § 89.809 (relating to exempt policies) shall provide coverage for the cost of the immunization of a child, up to 150% of the AWP of the immunizing agent, if the immunization conforms with ACIP standards in effect on May 21, 1992, governing the issuance of ACIP recommendations for the immunization of children. Those standards are as follows:
(i) The immunization practice is based upon both published and unpublished scientific literature as a means to address the morbidity and mortality of the disease.
(ii) The immunization practice is based upon labeling and packaging inserts for the immunizing agent.
(iii) The immunizing agent is safe and effective.
(iv) The schedule for use of the immunizing agent is administratively feasible.
(2) ACIP recommendations pertaining to the immunization of children are published in the MMWR. The Department of Health will deem an ACIP recommendation pertaining to the immunization of children to satisfy the standards set forth in this subsection unless ACIP alters its standards for recommending immunizations for children by eliminating a standard in this subsection and the recommendation is issued pursuant to those changed standards. An immunization practice which is recommended by ACIP pursuant to only the altered standards is not subject to the insurance coverage set forth in this subsection. An immunization practice which is recommended by ACIP pursuant to standards in addition to the standards enumerated in this subsection shall be deemed to satisfy the standards in this subsection.
(b) Notices. The Department of Health will place a notice in the Pennsylvania Bulletin listing MMWR publications containing ACIP recommendations issued pursuant to the standards in subsection (a). The Department of Health will publish the initial notice contemporaneously with the publication of this subchapter. The Department of Health will update that list in a notice which it will publish in the Pennsylvania Bulletin within 30 days after ACIP publishes a recommendation in the MMWR pursuant to the standards in subsection (a). The Department of Health will recommend that the list set forth in the initial notice and the update to the list set forth in a later notice be codified in the Pennsylvania Code. See Appendix G.
(c) Effective date of coverage. The insurance coverage set forth in subsection (a) shall be effective November 22, 1992, for a child immunization practice recommended by ACIP which was published in the MMWR on or before that date. Thereafter, the insurance coverage described in subsection (a) shall include a child immunization practice recommended by ACIP effective on the date the ACIP recommendation which is issued under the standards in subsection (a) is published in the MMWR.
Cross References This section cited in 31 Pa. Code § 89.801 (relating to authority and purpose; implementation); 31 Pa. Code § 89.802 (relating to definitions); 31 Pa. Code § 89.807 (relating to immunizing agents, doses and AWPs); 31 Pa. Code Chapter 89, Appendix G (relating to ACIP recommendations prescribing child immunization practices); and 31 Pa. Code Chapter 89, Appendix H (relating to immunizating agents and doses).
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