THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY MUSTIO, BOYD, BENNINGHOFF, CREIGHTON, FAIRCHILD, FLECK, GINGRICH, GRELL, GROVE, KAUFFMAN, KILLION, PICKETT, REICHLEY, ROAE, SAYLOR, STERN AND TURZAI, FEBRUARY 5, 2009

REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 5, 2009  

AN ACT

Amending the act of June 26, 2001 (P.L.755, No.77), entitled "An

act establishing a special fund and account for money

received by the Commonwealth from the Master Settlement

Agreement with tobacco manufacturers; providing for home and

community-based care, for tobacco use prevention and

cessation efforts, for Commonwealth universal research

enhancement, for hospital uncompensated care, for health

investment insurance, for medical assistance for workers with

disabilities, for regional biotechnology research centers,

for the HealthLink Program, for community-based health care

assistance programs, for PACE reinstatement and PACENET

expansion, for medical education loan assistance and for

percentage allocation and appropriation of moneys," in health

investment insurance, further providing for the adult basic

coverage insurance program.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Section 1303(b) and (d) of the act of June 26,

2001 (P.L.755, No.77), known as the Tobacco Settlement Act, are

amended and the section is amended by adding a subsection to

read:

Section 1303.  Adult basic coverage insurance program.

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(b)  Eligible adult responsibilities.--An eligible adult

seeking to purchase adult basic coverage insurance shall:

(1)  Submit an application to the department.

(2)  Pay to the department or its contractor an amount of

$30 per month of coverage or a monthly amount for coverage as

determined under subsection (b.1), as applicable. Beginning

January 1, 2003, the monthly payment amount shall be adjusted

based on the annual change in the Consumer Price Index for

the 12 preceding months for which data is available.

Notification of any change in the monthly payment amount

shall be provided to eligible adults participating in the

program.

(3)  Be responsible for any required copayments for

health care services rendered under the benefit package in

subsection (f)(2).

(4)  Notify the department or its contractor of any

change in the eligible adult's income.

(b.1)  Coverage and options.--Coverage and options are as

follows:

(1)  Eligible adults enrolled in the adult basic coverage

insurance program as of the effective date of this subsection

shall pay a monthly amount on a sliding scale set by the

department for the adult basic coverage insurance program.

This scale shall apply to eligible adults whose income is

between 150% and 200% of the Federal poverty level and shall

not be less than $60 per month and shall be updated once per

calendar year by providing notice in the Pennsylvania

Bulletin.

(2)  Eligible adults on the adult basic coverage

insurance program as of the effective date of this subsection

shall not be subject to a lifetime maximum benefit limit.

* * *

(d)  Potential waiting list.--

(1)  The department shall maintain a waiting list of

eligible adults who have applied for adult basic coverage

insurance but who are not enrolled due to insufficient

appropriations. An eligible adult on the waiting list may

purchase the benefit package at the monthly per member

premium cost negotiated by the department.

(2)  Eligible adults on the potential waiting list

transitioning on the adult basic coverage insurance program

on or after the effective date of this paragraph shall choose

between two options:

(i)  adult basic benefits with no deductible, with a

lifetime maximum benefit of $250,000; or

(ii)  a high-deductible health plan and health

savings account as authorized under section 223(c)(2) and

(d) of the Internal Revenue Code of 1986 (Public Law

99-514, 26 U.S.C. § 223(c)(2) and (d)). Eligible adults

choosing this option shall deposit into a health savings

account an amount equal to one-half the premium paid by

an eligible adult on the waiting list who purchases adult

basic benefits at cost. The high deductible health plan

in this section shall have a lifetime maximum benefit of

$1,000,000.

(3)  On a quarterly basis the department shall review

eligible adults in the adult basic coverage insurance program

and on the waiting list to ascertain whether or not they meet

income eligibility standards and whether or not there is an

alternative private sector insurance program, such as

dependent coverage, for which they could apply. Adults deemed

ineligible may be subject to termination of benefits and a

request for reimbursement to the Commonwealth if the total

monthly amounts stated in subsection (b.1)(1) exceed $1,000.

Adults affected by this section shall have recourse to

internal review procedures established by the department no

longer than 90 days after the effective date of this

paragraph.

(4)  On a monthly basis the department shall determine

the number of eligible adults who have discontinued their

participation in the program and shall transfer the same

number of eligible adults from the waiting list to the

program for participation provided they otherwise qualify.

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Section 2.  This act shall take effect in 60 days.