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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY MUSTIO, BOYD, BENNINGHOFF, CREIGHTON, FAIRCHILD, FLECK, GINGRICH, GRELL, GROVE, KAUFFMAN, KILLION, PICKETT, REICHLEY, ROAE, SAYLOR, STERN AND TURZAI, FEBRUARY 5, 2009 |
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| REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 5, 2009 |
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| AN ACT |
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1 | Amending the act of June 26, 2001 (P.L.755, No.77), entitled "An |
2 | act establishing a special fund and account for money |
3 | received by the Commonwealth from the Master Settlement |
4 | Agreement with tobacco manufacturers; providing for home and |
5 | community-based care, for tobacco use prevention and |
6 | cessation efforts, for Commonwealth universal research |
7 | enhancement, for hospital uncompensated care, for health |
8 | investment insurance, for medical assistance for workers with |
9 | disabilities, for regional biotechnology research centers, |
10 | for the HealthLink Program, for community-based health care |
11 | assistance programs, for PACE reinstatement and PACENET |
12 | expansion, for medical education loan assistance and for |
13 | percentage allocation and appropriation of moneys," in health |
14 | investment insurance, further providing for the adult basic |
15 | coverage insurance program. |
16 | The General Assembly of the Commonwealth of Pennsylvania |
17 | hereby enacts as follows: |
18 | Section 1. Section 1303(b) and (d) of the act of June 26, |
19 | 2001 (P.L.755, No.77), known as the Tobacco Settlement Act, are |
20 | amended and the section is amended by adding a subsection to |
21 | read: |
22 | Section 1303. Adult basic coverage insurance program. |
23 | * * * |
24 | (b) Eligible adult responsibilities.--An eligible adult |
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1 | seeking to purchase adult basic coverage insurance shall: |
2 | (1) Submit an application to the department. |
3 | (2) Pay to the department or its contractor an amount of |
4 | $30 per month of coverage or a monthly amount for coverage as |
5 | determined under subsection (b.1), as applicable. Beginning |
6 | January 1, 2003, the monthly payment amount shall be adjusted |
7 | based on the annual change in the Consumer Price Index for |
8 | the 12 preceding months for which data is available. |
9 | Notification of any change in the monthly payment amount |
10 | shall be provided to eligible adults participating in the |
11 | program. |
12 | (3) Be responsible for any required copayments for |
13 | health care services rendered under the benefit package in |
14 | subsection (f)(2). |
15 | (4) Notify the department or its contractor of any |
16 | change in the eligible adult's income. |
17 | (b.1) Coverage and options.--Coverage and options are as |
18 | follows: |
19 | (1) Eligible adults enrolled in the adult basic coverage |
20 | insurance program as of the effective date of this subsection |
21 | shall pay a monthly amount on a sliding scale set by the |
22 | department for the adult basic coverage insurance program. |
23 | This scale shall apply to eligible adults whose income is |
24 | between 150% and 200% of the Federal poverty level and shall |
25 | not be less than $60 per month and shall be updated once per |
26 | calendar year by providing notice in the Pennsylvania |
27 | Bulletin. |
28 | (2) Eligible adults on the adult basic coverage |
29 | insurance program as of the effective date of this subsection |
30 | shall not be subject to a lifetime maximum benefit limit. |
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1 | * * * |
2 | (d) Potential waiting list.-- |
3 | (1) The department shall maintain a waiting list of |
4 | eligible adults who have applied for adult basic coverage |
5 | insurance but who are not enrolled due to insufficient |
6 | appropriations. An eligible adult on the waiting list may |
7 | purchase the benefit package at the monthly per member |
8 | premium cost negotiated by the department. |
9 | (2) Eligible adults on the potential waiting list |
10 | transitioning on the adult basic coverage insurance program |
11 | on or after the effective date of this paragraph shall choose |
12 | between two options: |
13 | (i) adult basic benefits with no deductible, with a |
14 | lifetime maximum benefit of $250,000; or |
15 | (ii) a high-deductible health plan and health |
16 | savings account as authorized under section 223(c)(2) and |
17 | (d) of the Internal Revenue Code of 1986 (Public Law |
18 | 99-514, 26 U.S.C. § 223(c)(2) and (d)). Eligible adults |
19 | choosing this option shall deposit into a health savings |
20 | account an amount equal to one-half the premium paid by |
21 | an eligible adult on the waiting list who purchases adult |
22 | basic benefits at cost. The high deductible health plan |
23 | in this section shall have a lifetime maximum benefit of |
24 | $1,000,000. |
25 | (3) On a quarterly basis the department shall review |
26 | eligible adults in the adult basic coverage insurance program |
27 | and on the waiting list to ascertain whether or not they meet |
28 | income eligibility standards and whether or not there is an |
29 | alternative private sector insurance program, such as |
30 | dependent coverage, for which they could apply. Adults deemed |
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1 | ineligible may be subject to termination of benefits and a |
2 | request for reimbursement to the Commonwealth if the total |
3 | monthly amounts stated in subsection (b.1)(1) exceed $1,000. |
4 | Adults affected by this section shall have recourse to |
5 | internal review procedures established by the department no |
6 | longer than 90 days after the effective date of this |
7 | paragraph. |
8 | (4) On a monthly basis the department shall determine |
9 | the number of eligible adults who have discontinued their |
10 | participation in the program and shall transfer the same |
11 | number of eligible adults from the waiting list to the |
12 | program for participation provided they otherwise qualify. |
13 | * * * |
14 | Section 2. This act shall take effect in 60 days. |
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