PRINTER'S NO. 4704
No. 3011 Session of 2002
INTRODUCED BY CURRY, THOMAS, GRUCELA, BEBKO-JONES, BISHOP,
BROWNE, CAWLEY, DALEY, FRANKEL, HARHAI, JOSEPHS, MANDERINO,
MANN, MUNDY, ROEBUCK, SCRIMENTI, SHANER, STURLA, TIGUE AND
YOUNGBLOOD, NOVEMBER 26, 2002
REFERRED TO COMMITTEE ON INSURANCE, NOVEMBER 26, 2002
AN ACT
1 Requiring health insurance companies to reimburse health care
2 providers at specified rates; and conferring powers and
3 duties upon the Insurance Department.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Short title.
7 This act shall be known and may be cited as the Health
8 Insurance Reimbursement Act.
9 Section 2. Definitions.
10 The following words and phrases when used in this act shall
11 have the meanings given to them in this section unless the
12 context clearly indicates otherwise:
13 "Association." As defined in section 101 of the act of May
14 17, 1921 (P.L.682, No.284), known as The Insurance Company Law
15 of 1921.
16 "Commissioner." The Insurance Commissioner of the
17 Commonwealth.
1 "Company." As defined in section 101 of the act of May 17,
2 1921 (P.L.682, No.284), known as The Insurance Company Law of
3 1921.
4 "Department." The Insurance Department of the Commonwealth.
5 "Exchange." As defined in section 101 of the act of May 17,
6 1921 (P.L.682, No.284), known as The Insurance Company Law of
7 1921.
8 "Fraternal benefit society." An entity organized and
9 operating under Article XXIV of the act of May 17, 1921
10 (P.L.682, No.284), known as The Insurance Company Law of 1921.
11 "Health care provider." Any person, corporation, facility,
12 institution or other entity licensed, certified or approved by
13 the Commonwealth to provide health care or professional medical
14 services.
15 "Health insurance." Insurance coverage to cure or prevent
16 injury, disease or sickness.
17 "Health maintenance organization." An entity organized and
18 operating under the act of December 29, 1972 (P.L.1701, No.364),
19 known as the Health Maintenance Organization Act.
20 "Hospital plan corporation." An entity organized and
21 operating under 40 Pa.C.S. Ch. 61 (relating to hospital plan
22 corporations).
23 "Insurer." An entity licensed to issue health insurance in
24 this Commonwealth. The term includes any foreign or domestic
25 company, association or exchange, hospital plan corporation,
26 professional health services plan corporation, fraternal benefit
27 society or preferred provider organization.
28 "Preferred provider organization." An entity organized and
29 operating under section 630 of the act of May 17, 1921 (P.L.682,
30 No.284), known as The Insurance Company Law of 1921.
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1 "Professional health services plan corporation." An entity
2 organized and operating under 40 Pa.C.S. Ch. 63 (relating to
3 professional health services plan corporations).
4 Section 3. Reimbursement.
5 (a) Requirement.--In a policy of health insurance issued or
6 renewed on or after the effective date of this section, an
7 insurer must agree to reimburse an insured or a health care
8 provider for covered medical services at the minimum rate of
9 113% of the amount in the schedule of medical assistance
10 payments under Title XIX of the Social Security Act (49 Stat.
11 620, 42 U.S.C. § 1396 et seq.).
12 (b) Effect.--The department shall not approve a policy of
13 health insurance which is in violation of subsection (a).
14 Section 20. Effective date.
15 This act shall take effect in 60 days.
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