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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY DeLUCA, BELFANTI, CONKLIN, D. COSTA, DONATUCCI, GOODMAN, KIRKLAND, KORTZ, KULA, MUNDY, M. O'BRIEN, PICKETT, SEIP, STABACK, J. TAYLOR AND WHITE, MARCH 5, 2009 |
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| REFERRED TO COMMITTEE ON INSURANCE, MARCH 5, 2009 |
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| AN ACT |
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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," further providing for conditions |
12 | subject to which policies are to be issued; providing for |
13 | health insurance coverage for certain children of insured |
14 | parents and for affordable small group health care coverage; |
15 | and making inconsistent repeals. |
16 | The General Assembly of the Commonwealth of Pennsylvania |
17 | hereby enacts as follows: |
18 | Section 1. Section 617(A)(3) and (9) of the act of May 17, |
19 | 1921 (P.L.682, No.284), known as The Insurance Company Law of |
20 | 1921, added May 25, 1951 (P.L.417, No.99) and January 18, 1968 |
21 | (1967 P.L.969, No.433), are amended to read: |
22 | Section 617. Conditions Subject to Which Policies Are to Be |
23 | Issued.--(A) No such policy shall be delivered or issued for |
24 | delivery to any person in this Commonwealth unless: |
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1 | * * * |
2 | (3) it purports to insure only one person, except that a |
3 | policy may insure, originally or by subsequent amendment, upon |
4 | the application of an adult head of a family who shall be deemed |
5 | the policyholder, any two or more eligible members of that |
6 | family, including husband, wife, dependent children or any |
7 | children under a specified age which, except as provided under |
8 | section 617.1, shall not exceed nineteen years and any other |
9 | person dependent upon the policyholder; and |
10 | * * * |
11 | (9) A policy delivered or issued for delivery after January |
12 | 1, 1968, under which coverage of a dependent of a policyholder |
13 | terminates at a specified age shall, with respect to an |
14 | unmarried child covered by the policy prior to the attainment of |
15 | the age of nineteen or except as provided under section 617.1, |
16 | the age of thirty, who is incapable of self-sustaining |
17 | employment by reason of mental retardation or physical handicap |
18 | and who became so incapable prior to attainment of age nineteen |
19 | and who is chiefly dependent upon such policyholder for support |
20 | and maintenance, not so terminate while the policy remains in |
21 | force and the dependent remains in such condition, if the |
22 | policyholder has within thirty-one days of such dependent's |
23 | attainment of the limiting age submitted proof of such |
24 | dependent's incapacity as described herein. The foregoing |
25 | provisions of this paragraph shall not require an insurer to |
26 | insure a dependent who is a mentally retarded or physically |
27 | handicapped child where the policy is underwritten on evidence |
28 | of insurability based on health factors set forth in the |
29 | application or where such dependent does not satisfy the |
30 | conditions of the policy as to any requirement for evidence of |
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1 | insurability or other provisions of the policy, satisfaction of |
2 | which is required for coverage thereunder to take effect. In any |
3 | such case the terms of the policy shall apply with regard to the |
4 | coverage or exclusion from coverage of such dependent. |
5 | * * * |
6 | Section 2. The act is amended by adding a section to read: |
7 | Section 617.1. Health Insurance Coverage for Certain |
8 | Children of Insured Parents.--(A) An insurer that issues, |
9 | delivers, executes or renews health care insurance in this |
10 | Commonwealth, under which coverage of a child would otherwise |
11 | terminate at a specified age, shall, at the option of the |
12 | child's parent or guardian, provide coverage to a child of the |
13 | insured beyond that specified age, up through the age of twenty- |
14 | nine, provided that the child meet all of the following |
15 | requirements: |
16 | (1) Is not married. |
17 | (2) Has no dependents. |
18 | (3) Is a resident of this Commonwealth or is enrolled as a |
19 | full-time student at an institution of higher education in this |
20 | Commonwealth. |
21 | (4) Is not covered by another health insurance policy. |
22 | (B) An insured may exercise the option provided under |
23 | subsection (A) at any time during the term of the policy by |
24 | notice to the insurer. |
25 | (C) Employers shall not be required to contribute to any |
26 | increased premium charged by the insurer for the exercise of the |
27 | option provided under subsection (A), but the contributions may |
28 | be agreed to by the employer. |
29 | (D) This section shall not include the following types of |
30 | insurance or any combination thereof: |
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1 | (1) Hospital indemnity. |
2 | (2) Accident. |
3 | (3) Specified disease. |
4 | (4) Disability income. |
5 | (5) Dental. |
6 | (6) Vision. |
7 | (7) Civilian Health and Medical Program of the Uniformed |
8 | Services (CHAMPUS) supplement. |
9 | (8) Medicare supplement. |
10 | (9) Long-term care. |
11 | (10) Other limited benefit plans. |
12 | Section 3. The act is amended by adding an article to read: |
13 | ARTICLE XLII |
14 | AFFORDABLE SMALL GROUP HEALTH CARE COVERAGE |
15 | Section 4201. Scope of article. |
16 | This article relates to health care reform. |
17 | Section 4202. Definitions. |
18 | The following words and phrases when used in this article |
19 | shall have the meanings given to them in this section unless the |
20 | context clearly indicates otherwise: |
21 | "Accident and Health Filing Reform Act." The act of December |
22 | 18, 1996 (P.L.1066, No.159), known as the Accident and Health |
23 | Filing Reform Act. |
24 | "Commissioner." The Insurance Commissioner of the |
25 | Commonwealth. |
26 | "Commonwealth Attorneys Act." The act of October 15, 1980 |
27 | (P.L.950, No.164), known as the Commonwealth Attorneys Act. |
28 | "Commonwealth Documents Law." The act of July 31, 1968 |
29 | (P.L.769, No.240), referred to as the Commonwealth Documents |
30 | Law. |
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1 | "Department." The Insurance Department of the Commonwealth. |
2 | "Health benefit plan." Any individual or group health |
3 | insurance policy, subscriber contract, certificate or plan which |
4 | provides health or sickness and accident coverage which is |
5 | offered by an insurer. The term shall not include any of the |
6 | following: |
7 | (1) An accident only policy. |
8 | (2) A credit only policy. |
9 | (3) A long-term or disability income policy. |
10 | (4) A specified disease policy. |
11 | (5) A Medicare supplement policy. |
12 | (6) A Civilian Health and Medical Program of the |
13 | Uniformed Services (CHAMPUS) supplement policy. |
14 | (7) A fixed indemnity policy. |
15 | (8) A dental only policy. |
16 | (9) A vision only policy. |
17 | (10) A workers' compensation policy. |
18 | (11) An automobile medical payment policy under 75 |
19 | Pa.C.S. (relating to vehicles). |
20 | (12) Any other similar policies providing for limited |
21 | benefits. |
22 | "Health care-associated infection." A localized or systemic |
23 | condition that results from an adverse reaction to the presence |
24 | of an infectious agent or its toxins and meets all of the |
25 | following: |
26 | (1) Occurs in a patient in a health care setting. |
27 | (2) Was not present or incubating at the time of |
28 | admission, unless the infection was related to a previous |
29 | admission to the same setting. |
30 | (3) If occurring in a hospital setting, meets the |
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1 | criteria for a specific infection site as defined by the |
2 | Centers for Disease Control and Prevention and its National |
3 | Health Care Safety Network. |
4 | "Health insurance region." Any of the following: |
5 | (1) "Region I." The geographic area covered by the |
6 | counties of Bucks, Chester, Delaware, Montgomery and |
7 | Philadelphia. |
8 | (2) "Region II." The geographic area covered by the |
9 | counties of Adams, Berks, Cumberland, Dauphin, Franklin, |
10 | Fulton, Lancaster, Lebanon, Lehigh, Northampton, Perry, |
11 | Schuylkill and York. |
12 | (3) "Region III." The geographic area covered by the |
13 | counties of Bradford, Carbon, Clinton, Lackawanna, Luzerne, |
14 | Lycoming, Monroe, Pike, Sullivan, Susquehanna, Tioga, Wayne |
15 | and Wyoming. |
16 | (4) "Region IV." The geographic area covered by the |
17 | counties of Centre, Columbia, Juniata, Mifflin, Montour, |
18 | Northumberland, Synder and Union. |
19 | (5) "Region V." The geographic area covered by the |
20 | counties of Bedford, Blair, Cambria, Clearfield, Huntingdon, |
21 | Jefferson and Somerset. |
22 | (6) "Region VI." The geographic area covered by the |
23 | counties of Allegheny, Armstrong, Beaver, Butler, Fayette, |
24 | Greene, Indiana, Lawrence, Washington and Westmoreland. |
25 | (7) "Region VII." The geographic area covered by the |
26 | counties of Cameron, Clarion, Crawford, Elk, Erie, Forest, |
27 | McKean, Mercer, Potter, Venango and Warren. |
28 | "Individual market." The health insurance market for |
29 | individuals as defined under section 2791 of the Health |
30 | Insurance Portability and Accountability Act of 1996 (Public Law |
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1 | 104-191, 110 Stat. 1936). |
2 | "Insurer." A company or health insurance entity licensed in |
3 | this Commonwealth to issue any individual or group health, |
4 | sickness or accident policy or subscriber contract or |
5 | certificate or plan that provides medical or health care |
6 | coverage by a health care facility or licensed health care |
7 | provider that is offered or governed under this act or any of |
8 | the following: |
9 | (1) The act of December 29, 1972 (P.L.1701, No.364), |
10 | known as the Health Maintenance Organization Act. |
11 | (2) The act of May 18, 1976 (P.L.123, No.54), known as |
12 | the Individual Accident and Sickness Insurance Minimum |
13 | Standards Act. |
14 | (3) 40 Pa.C.S. Ch. 61 (relating to hospital plan |
15 | corporations) or Ch. 63 (relating to professional health |
16 | services plan corporations). |
17 | "Insurer group." A group of insurers writing coverage in |
18 | this Commonwealth, including a parent insurer, its subsidiaries |
19 | and affiliates. |
20 | "Large group market." The health insurance market for the |
21 | large group market as defined under section 2791 of the Health |
22 | Insurance Portability and Accountability Act of 1996 (Public Law |
23 | 104-191, 110 Stat. 1936). |
24 | "Medical loss ratio." The ratio of incurred medical claim |
25 | costs to earned premiums. |
26 | "Regulatory Review Act." The act of June 25, 1982 (P.L.633, |
27 | No.181), known as the Regulatory Review Act. |
28 | "Small employer." In connection with a group health plan |
29 | with respect to a calendar year and a plan year, an employer who |
30 | employs an average of at least two but not more than 50 |
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1 | employees on business days during the preceding calendar year |
2 | and who employs at least two such employees on the first day of |
3 | the plan year. In the case of an employer which was not in |
4 | existence throughout the preceding calendar year, the |
5 | determination whether an employer is a small employer shall be |
6 | based on the average number of employees that it is reasonably |
7 | expected that the employer will employ on business days in the |
8 | current calendar year. |
9 | "Small group health benefit plan." A health benefit plan |
10 | offered to a small employer. |
11 | "Small group market." The health insurance market for the |
12 | small group market as defined in section 2791 of the Health |
13 | Insurance Portability and Accountability Act of 1996 (Public Law |
14 | 104-191, 110 Stat. 1936). |
15 | "Standard plan." One of the health benefit packages |
16 | established by the Insurance Department in accordance with |
17 | section 4203. |
18 | Section 4203. Standard plans. |
19 | (a) Applicability.--This section shall apply to all small |
20 | group health benefit plans issued, made effective, delivered or |
21 | renewed in this Commonwealth after the effective date of this |
22 | section. |
23 | (b) Standard plans required.-- |
24 | (1) An insurer shall not offer a plan that does not meet |
25 | the minimum benefits specified in one of the standard plans |
26 | developed by the department in accordance with the following |
27 | criteria: |
28 | (i) The standard plans shall not include coverage |
29 | for behavioral health services except as required by |
30 | Federal law. |
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1 | (ii) The standard plans may not contain any |
2 | preexisting condition exclusions. |
3 | (2) Standard plans may include options for deductibles |
4 | and cost-sharing if the department determines that the |
5 | options: |
6 | (i) Do not dissuade consumers from seeking necessary |
7 | services. |
8 | (ii) Promote a balance of the impact of cost-sharing |
9 | in reducing premiums and in effecting utilization of |
10 | appropriate services. |
11 | (iii) Limit the total cost-sharing that may be |
12 | incurred by an individual in a year. |
13 | (3) The following apply: |
14 | (i) The department shall forward notice of the |
15 | elements of the standard plans to the Legislative |
16 | Reference Bureau for publication as a notice in the |
17 | Pennsylvania Bulletin. |
18 | (ii) An insurer subject to the provisions of this |
19 | section shall be required to begin offering its standard |
20 | plans as soon as practicable following the publication |
21 | but in no event later than 180 days following the |
22 | publication under subparagraph (i). |
23 | (c) Additional benefits.-- |
24 | (1) An insurer shall offer as an additional benefit to |
25 | every standard plan a behavioral health services benefit that |
26 | complies with the provisions of sections 601-A, 602-A, 603-A, |
27 | 604-A, 605-A, 606-A, 607-A and 608-A. |
28 | (2) An insurer may offer benefits in addition to those |
29 | in any of its standard plans. |
30 | (3) Each additional benefit shall: |
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1 | (i) Be offered and priced separately from benefits |
2 | specified in the standard plan with which the benefits |
3 | are being offered. |
4 | (ii) Not have the effect of duplicating any of the |
5 | benefits in the standard plan with which the benefits are |
6 | being offered. |
7 | (iii) Be clearly specified as additions to the |
8 | standard plan with which the benefits are being offered. |
9 | (4) The department may prohibit an insurer from offering |
10 | an additional benefit under this section if the department |
11 | finds that the additional benefit will be sold in conjunction |
12 | with one of the insurer's standard plans in a manner designed |
13 | to promote risk selection or underwriting practices otherwise |
14 | prohibited under this section or other State law. |
15 | Section 4204. Health insurance premium rates for dominant |
16 | insurers. |
17 | (a) Applicability.--This section shall apply to all small |
18 | group health benefit plans that are issued, made effective, |
19 | delivered or renewed in this Commonwealth after the effective |
20 | date of this section, by an insurer that is part of an insurer |
21 | group, if that insurer group insures 10% or more of the covered |
22 | lives in the health insurance region in which the plan is being |
23 | issued, made effective, delivered or renewed. |
24 | (b) Premium rates.-- |
25 | (1) An insurer shall establish a base rate for plans and |
26 | shall file the base rates with the department as required by |
27 | law. An insurer may adjust its base rates for the following: |
28 | (i) Age. |
29 | (ii) Health insurance region. |
30 | (iii) Wellness incentives as determined by the |
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1 | department. |
2 | (2) An insurer shall apply all risk adjustment factors |
3 | under paragraph (1) consistently with respect to all plans |
4 | subject to this section and consistently with department |
5 | regulatory authority. |
6 | (3) An insurer shall not charge a rate that is more than |
7 | 33% above or below the community rate, as adjusted as |
8 | permitted under paragraph (1). Additional adjustments may be |
9 | made to reflect the inclusion of additional benefits as |
10 | specified under section 4203(c) and differences in family |
11 | composition. |
12 | (4) The premium for a small group health benefit plan |
13 | shall not be adjusted by an insurer more than once each year, |
14 | except that rates may be changed more frequently to reflect: |
15 | (i) Changes to the enrollment of the small employer |
16 | group. |
17 | (ii) Changes to a small group health benefit plan |
18 | that have been requested by the small employer. |
19 | (iii) Changes to the family composition of |
20 | employees. |
21 | (iv) Changes pursuant to a government order or |
22 | judicial proceeding. |
23 | (5) An insurer shall base its rating methods and |
24 | practices on commonly accepted actuarial assumptions and |
25 | sound actuarial principles. Rates shall not be excessive, |
26 | inadequate or unfairly discriminatory. |
27 | (6) For purposes of this subsection, an insurer's "base |
28 | rate" for a plan shall refer to a rating methodology that is |
29 | based on the experience of all risks covered by the plan |
30 | without regard to health status, occupation or any other |
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1 | factor. |
2 | (c) Additional rate review and prior approval.-- |
3 | (1) In conjunction with and in addition to the standards |
4 | set forth in the Accident and Health Filing Reform Act and |
5 | all other applicable statutory and regulatory requirements, |
6 | all rate filings shall be subject to prior approval by the |
7 | department within the 45-day period provided by section 3(f) |
8 | of the Accident and Health Filing Reform Act. |
9 | (2) In conjunction with and in addition to the standards |
10 | set forth under the Accident and Health Filing Reform Act and |
11 | all other applicable statutory and regulatory requirements, |
12 | the department may disapprove a rate filing based upon any of |
13 | the following: |
14 | (i) The rate is not actuarially sound. |
15 | (ii) The increase is requested because the insurer |
16 | has not operated efficiently or has factored in |
17 | experience that conflicts with recognized best practices |
18 | in the health care industry, including the allocation of |
19 | administrative expenses to the plan on a less favorable |
20 | basis than expenses are allocated to other health benefit |
21 | plans. |
22 | (iii) The increase is requested because the insurer |
23 | has incurred costs due to failure to follow best |
24 | practices for cost control, including costs due to |
25 | avoidable health care-associated infections and avoidable |
26 | hospitalizations due to ineffective chronic care |
27 | management. |
28 | (iv) The medical loss ratio for a plan is less than |
29 | 85%. |
30 | (3) In the event a plan has a medical loss ratio of less |
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1 | than 85%, the department may, in addition to any other |
2 | remedies available under law, require the insurer to refund |
3 | the difference to policyholders on a pro rata basis as soon |
4 | as practicable following receipt of notice from the |
5 | department of the requirement but in no event later than 120 |
6 | days following receipt of the notice. The department shall |
7 | establish procedures under which such refunds will be made. |
8 | (d) Procedures.--The filing and review procedures set forth |
9 | under the Accident and Health Filing Reform Act shall apply to |
10 | any filing conducted under this section, except that no filing |
11 | deemed to meet the requirements of this act shall take effect |
12 | unless the department receives written notice of the insurer's |
13 | intent to exercise the right granted under this section at least |
14 | ten calendar days prior to the effective date of this section. |
15 | Section 4205. Health insurance premium rates for nondominant |
16 | insurers. |
17 | (a) Applicability.--This section applies to all small group |
18 | health benefit plans that are issued, made effective, delivered |
19 | or renewed in this Commonwealth after the effective date of this |
20 | section, by an insurer that is part of an insurer group, if that |
21 | insurer group insures less than 10% of the covered lives in the |
22 | region in which the plan is being issued, made effective, |
23 | delivered or renewed. |
24 | (b) Premium rates.-- |
25 | (1) An insurer shall establish a base rate for plans and |
26 | shall file the base rates with the department as required by |
27 | law. An insurer may modify its base rates only by the |
28 | following demographic factors: |
29 | (i) Age. |
30 | (ii) Health insurance region. |
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1 | (iii) Industry or class of business. |
2 | (iv) Wellness incentives as determined by the |
3 | department. |
4 | (2) An insurer shall apply all risk adjustment factors |
5 | under paragraph (1) consistently with respect to all plans |
6 | subject to this section and consistently with department |
7 | regulatory authority. |
8 | (3) An insurer shall not charge a rate that is more than |
9 | 50% above or below the base rate, as adjusted as permitted |
10 | under paragraph (1). Additional adjustments may be made to |
11 | reflect the inclusion of additional benefits as specified in |
12 | section 4203(c) and differences in family composition. |
13 | (4) The premium for a small group health benefit plan |
14 | shall not be adjusted by an insurer more than once each year, |
15 | except that rates may be changed more frequently to reflect: |
16 | (i) Changes to the enrollment of the small employer |
17 | group. |
18 | (ii) Changes to a small group health benefit plan |
19 | that have been requested by the small employer. |
20 | (iii) Changes to the family composition of |
21 | employees. |
22 | (iv) Changes pursuant to a government order or |
23 | judicial proceeding. |
24 | (5) An insurer shall base its rating methods and |
25 | practices on commonly accepted actuarial assumptions and |
26 | sound actuarial principles. Rates shall not be excessive, |
27 | inadequate, or unfairly discriminatory. |
28 | (6) For purposes of this subsection, an insurer's "base |
29 | rate" for a plan shall refer to a rating methodology that is |
30 | based on the experience of all risks covered by the plan |
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1 | without regard to health status, occupation or any other |
2 | factor. |
3 | (c) Additional rate review and prior approval.-- |
4 | (1) In conjunction with and in addition to the standards |
5 | set forth in the Accident and Health Filing Reform Act and |
6 | all other applicable statutory and regulatory requirements, |
7 | all rate filings shall be subject to prior approval by the |
8 | department within the 45-day period provided by section 3(f) |
9 | of the Accident and Health Filing Reform Act. |
10 | (2) In conjunction with and in addition to the standards |
11 | set forth in the Accident and Health Filing Reform Act and |
12 | all other applicable statutory and regulatory requirements, |
13 | the department may disapprove a rate filing based upon any of |
14 | the following: |
15 | (i) The rate is not actuarially sound. |
16 | (ii) The increase is requested because the insurer |
17 | has not operated efficiently or has factored in |
18 | experience that conflicts with recognized best practices |
19 | in the health care industry, including the allocation of |
20 | administrative expenses to the plan on a less favorable |
21 | basis than expenses are allocated to other health benefit |
22 | plans. |
23 | (iii) The increase is requested because the insurer |
24 | has incurred costs due to failure to follow best |
25 | practices for cost control, including costs due to |
26 | avoidable health care-associated infections and avoidable |
27 | hospitalizations due to ineffective chronic care |
28 | management. |
29 | (d) Procedures.--The filing and review procedures set forth |
30 | in the Accident and Health Filing Reform Act shall apply to any |
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1 | filing conducted under this section, except that no filing |
2 | deemed to meet the requirements of this act shall take effect |
3 | unless the department receives written notice of the insurer's |
4 | intent to exercise the right granted under this section at least |
5 | ten calendar days prior to the effective date of this section. |
6 | Section 4206. College student insurance requirements. |
7 | (a) Minimum health benefit package.--Within 90 days |
8 | following the effective date of this section, the commissioner |
9 | shall establish a minimum health benefit package for full-time |
10 | students enrolled in public or private baccalaureate and |
11 | postbaccalaureate programs in this Commonwealth and transmit a |
12 | description of the package to the Legislative Reference Bureau |
13 | for publication in the Pennsylvania Bulletin. As soon as |
14 | practicable after the date of publication of the package, but in |
15 | no event later than 120 days following the publication, all |
16 | insurers shall offer the package as individual coverage |
17 | available to students and as group coverage through the |
18 | institution. The commissioner may make revisions to the minimum |
19 | health benefit package periodically, but no more than one time |
20 | per 12-month period. Each revision shall be implemented by |
21 | insurers as soon as practicable following publication of the |
22 | revision in the Pennsylvania Bulletin, but in no event later |
23 | than 120 days following such publication. |
24 | (b) Required health insurance coverage.-- |
25 | (1) Every full-time student enrolled in a public or |
26 | private baccalaureate or postbaccalaureate program in this |
27 | Commonwealth shall maintain health insurance coverage which |
28 | provides the minimum benefit package established under this |
29 | section. The coverage shall be maintained throughout the |
30 | period of the student's enrollment. |
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1 | (2) Every student required to meet the mandatory |
2 | coverage under this section shall present evidence of such |
3 | coverage to the institution in which the student is enrolled |
4 | at least annually, in a manner prescribed by the institution. |
5 | (3) Every public or private college or university or |
6 | postbaccalaureate program in this Commonwealth shall make |
7 | available health insurance coverage on a group or individual |
8 | basis for purchase by students who are required to maintain |
9 | the coverage under this section. |
10 | (4) Notwithstanding paragraphs (1), (2) and (3), the |
11 | requirements of this section may be satisfied if the |
12 | baccalaureate or postbaccalaureate program provides on-campus |
13 | student health care coverage equivalent to the minimum |
14 | benefit package through its own clinics and health care |
15 | facilities and receives approval from the Department of |
16 | Education, in consultation with the department, that such |
17 | coverage is equivalent. The coverage shall provide that the |
18 | student is covered for hospital admissions and emergency |
19 | services at facilities throughout this Commonwealth. |
20 | (b) Effective date.--This section shall apply to every |
21 | public or private baccalaureate or postbaccalaureate program in |
22 | this Commonwealth beginning the first August 1 following 180 |
23 | days after the publication of the notice of the elements of the |
24 | standard plans. |
25 | (c) Annual certification.--Every public or private |
26 | baccalaureate or postbaccalaureate program in this Commonwealth |
27 | shall certify to the Department of Education at least annually |
28 | that the requirements of this section have been met for all |
29 | periods of the preceding year. |
30 | (d) Penalty for failure to comply.--The Secretary of |
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1 | Education may impose a fine of up to $500 per day for each day |
2 | that a public or private baccalaureate or postbaccalaureate |
3 | program fails to meet any of its obligations in this section. |
4 | The fine shall be due within 30 days following receipt by the |
5 | institution of notice of the violation. Funds collected under |
6 | this subsection and any returns on the funds shall be deposited |
7 | into the Tobacco Settlement Fund established under the act of |
8 | June 26, 2001 (P.L.755, No.77), known as the Tobacco Settlement |
9 | Act. |
10 | Section 4207. Fair marketing standards. |
11 | Every insurer and producer must meet the following standards, |
12 | as appropriate: |
13 | (1) An insurer that offers small group health benefit |
14 | plans shall offer to small employers all of the small group |
15 | health benefit plans that the insurer actively markets in |
16 | this Commonwealth. An insurer shall be considered to be |
17 | actively marketing a small group health benefit plan if it |
18 | offers that plan to any small group not currently covered by |
19 | that insurer. |
20 | (2) The following shall apply: |
21 | (i) Except as provided in subparagraph (ii), a |
22 | producer or an insurer that provides small group health |
23 | benefit plans shall not encourage or direct a small |
24 | employer to refrain from filing an application for |
25 | coverage with the insurer or seek coverage from another |
26 | insurer because of a health status-related factor or the |
27 | nature of the industry, occupation or geographic location |
28 | of the small employer. |
29 | (ii) The provisions of subparagraph (i) shall not |
30 | apply with respect to information provided by an insurer |
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1 | or producer to a small employer regarding an established |
2 | geographic service area or a restricted network provision |
3 | of an insurer. |
4 | (3) An insurer that provides small group health benefit |
5 | plans shall not enter into a contract, agreement or |
6 | arrangement that provides for or results in a producer's |
7 | compensation being varied because of a health status-related |
8 | factor or the nature of the industry or occupation of the |
9 | small employer. |
10 | (4) An insurer that provides small group health benefit |
11 | plans shall not terminate, fail to renew or limit its |
12 | contract or agreement with a producer for a reason related to |
13 | a health status-related factor or occupation of the small |
14 | employer. |
15 | (5) A producer or insurer that provides small group |
16 | health benefit plans shall not induce or encourage a small |
17 | employer to exclude an employee or the employee's dependents |
18 | from health coverage or benefits available under the plan. |
19 | Section 4208. Reporting requirements. |
20 | (a) Health insurance region market share.--Not less |
21 | frequently than March 1 of every calendar year, each insurer |
22 | group shall file a report with the department of the insurer |
23 | group's small group market share by health insurance region and |
24 | the small group market share of each insurer within the insurer |
25 | group by health insurance region, for the immediately preceding |
26 | calendar year. |
27 | (b) Segregated report.--Not less frequently than March 1 of |
28 | every calendar year, each insurer and each insurer group shall |
29 | file a report with the department for the immediately preceding |
30 | calendar year. The report shall contain the following |
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1 | information, both Statewide and by health insurance region, |
2 | segregated for the individual market, the small group market and |
3 | the large group market: |
4 | (1) The aggregate number of covered lives and the time |
5 | periods over which coverage was provided. |
6 | (2) The number of individuals and groups covered by |
7 | health benefit plans issued, made effective, delivered or |
8 | renewed. |
9 | (3) The aggregate loss ratio for all policies issued, |
10 | made effective, delivered or renewed. |
11 | (4) The average annual premium per insured life. |
12 | (5) The average claims cost per insured life. |
13 | (6) The range of administrative expenses, commissions |
14 | paid, profit load, and any other retention items. |
15 | (7) The average administrative expenses, commissions |
16 | paid and profit load and any other retention items. |
17 | (8) A description of each rating method used to |
18 | determine rates indicating the specific group size for which |
19 | each method was used. |
20 | (9) A listing of all factors used in the rating for each |
21 | market and the range of these factors. |
22 | (10) The number of groups, including the number of |
23 | employees and members in those groups, covered by entities |
24 | with administrative services contract or administrative |
25 | services only arrangements. |
26 | (c) Review of reports.--By July 1 of each year, the |
27 | department shall review the reports provided for under |
28 | subsection (a) and shall transmit to the Legislative Reference |
29 | Bureau for publication in the Pennsylvania Bulletin a statement |
30 | of the status of each insurer within each region in which the |
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1 | insurer provides coverage. |
2 | (d) Data calls.--The department may issue data calls as |
3 | necessary to fulfill the requirements of this article. Any data |
4 | calls issued under this section shall be published in the |
5 | Pennsylvania Bulletin. |
6 | (e) Limitation.--The commissioner shall have discretion to |
7 | modify the reporting requirements of this section by |
8 | transmitting notice to the Legislative Reference Bureau for |
9 | publication in the Pennsylvania Bulletin. |
10 | (f) Compliance.--For failure to comply with any reports or |
11 | data calls required under this section, the commissioner shall |
12 | impose an administrative penalty of $1,000 against each insurer |
13 | or $5,000 against each insurer group for every day that the |
14 | report or data is not provided in accordance with this section. |
15 | Section 4209. Regulations. |
16 | (a) Implementation and administration.--The department and |
17 | the Department of Education may promulgate regulations as |
18 | necessary for the implementation and administration of this |
19 | article. |
20 | (b) Exemption.--Except as may be otherwise provided in this |
21 | article, the promulgation of regulations under this article by |
22 | the department or the Department of Education shall, until three |
23 | years from the effective date of this section, be exempt from |
24 | the following: |
25 | (1) Sections 201 through 205 of the Commonwealth |
26 | Documents Law. |
27 | (2) The Commonwealth Attorneys Act. |
28 | (3) The Regulatory Review Act. |
29 | Section 4210. Enforcement. |
30 | (a) Determination of violation.--Upon a determination that a |
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1 | person licensed by the department has violated any provision of |
2 | this article, the department may, subject to 2 Pa.C.S. Chs. 5 |
3 | Subch. A (relating to practice and procedure of Commonwealth |
4 | agencies) and 7 Subch. A (relating to judicial review of |
5 | Commonwealth agency action), do any of the following: |
6 | (1) Issue an order requiring the person to cease and |
7 | desist from engaging in the violation. |
8 | (2) Suspend or revoke or refuse to issue or renew the |
9 | certificate or license of the offending party or parties. |
10 | (3) Impose an administrative penalty of up to $5,000 for |
11 | each violation. |
12 | (4) Seek restitution. |
13 | (5) Impose any other penalty or pursue any other remedy |
14 | deemed appropriate by the commissioner. |
15 | (b) Other remedies.--The enforcement remedies imposed under |
16 | this section shall be in addition to any other remedies or |
17 | penalties that may be imposed by any other statute, including: |
18 | (1) The act of July 22, 1974 (P.L.589, No.205), known as |
19 | the Unfair Insurance Practices Act. A violation by any person |
20 | of this article is deemed an unfair method of competition and |
21 | an unfair or deceptive act or practice pursuant to the Unfair |
22 | Insurance Practices Act. |
23 | (2) The act of December 18, 1996 (P.L.1066, No.159), |
24 | known as the Accident and Health Filing Reform Act. |
25 | (c) Private cause of action.--Nothing in this article shall |
26 | be construed as to create or imply a private cause of action for |
27 | violation of this article. |
28 | Section 4. Repeals are as follows: |
29 | (1) The General Assembly declares that the repeal under |
30 | paragraph (2) is necessary to effectuate the addition of |
|
1 | Article XLII of the act. |
2 | (2) Section 3(e)(2), (3), (4) and (5) of the act of |
3 | December 18, 1996 (P.L.1066, No.159), known as the Accident |
4 | and Health Filing Reform Act, are repealed insofar as they |
5 | apply to small group health benefit plan rates. |
6 | (3) All other acts and parts of acts are repealed |
7 | insofar as they are inconsistent with the addition of Article |
8 | XLII of the act. |
9 | Section 5. This act shall take effect as follows: |
10 | (1) The amendment or addition of sections 617(A)(3) and |
11 | (9) and 617.1 of the act shall take effect in 60 days. |
12 | (2) The remainder of this act shall take effect |
13 | immediately. |
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