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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY MURT, CALTAGIRONE, CLYMER, DONATUCCI, EVERETT, HARHART, MILLARD, MOUL, VULAKOVICH AND D. COSTA, MAY 12, 2011 |
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| REFERRED TO COMMITTEE ON INSURANCE, MAY 12, 2011 |
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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 forms for |
12 | health insurance claims. |
13 | The General Assembly of the Commonwealth of Pennsylvania |
14 | hereby enacts as follows: |
15 | Section 1. Section 1202 of the act of May 17, 1921 (P.L.682, |
16 | No.284), known as The Insurance Company Law of 1921, added |
17 | December 15, 1992 (P.L.1129, No.148), is amended to read: |
18 | Section 1202. Forms for Health Insurance Claims.--(a) Each |
19 | health insurance claim form processed or otherwise used by an |
20 | insurer, including those used by the Department of Public |
21 | Welfare for public health care coverage, shall be the uniform |
22 | claim form developed by the department. The claim form shall be |
23 | identical in form and content except as provided in [subsection |
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1 | (c)] subsections (c) and (c.1). The department shall, in |
2 | consultation with the Department of Public Welfare, insurers and |
3 | health care providers or their representatives, first consider |
4 | the feasibility of utilizing the UB-82/HCFA-1450 and HCFA-1500 |
5 | forms, or their successors, as a uniform claim form. If these |
6 | forms are deemed to be unsatisfactory, the department shall, in |
7 | consultation with the Department of Public Welfare, insurers and |
8 | health care providers or their representatives, develop a |
9 | uniform claim form for use by all insurers, the Department of |
10 | Public Welfare's public health care coverage program and health |
11 | care providers. The uniform claim form shall contain blank |
12 | spaces at appropriate places in the document for approved |
13 | additional information requests under subsection (c). |
14 | (b) The feasibility study and subsequent development of the |
15 | uniform claim form shall be complete within one hundred eighty |
16 | (180) days of the effective date of this article. All insurers, |
17 | the Department of Public Welfare's public health care coverage |
18 | program and health care providers shall be required to use the |
19 | uniform claim form within one hundred twenty (120) days after |
20 | the uniform claim form is developed. The department may consider |
21 | a request from the Department of Public Welfare for an extension |
22 | in meeting the implementation schedule of this section. |
23 | (c) (1) Subject to the procedure contained in clause (2), |
24 | an insurer may request that a claimant provide departmentally |
25 | approved additional information which is not requested on the |
26 | uniform claim form. |
27 | (2) An insurer may request departmental approval of |
28 | additional information requests to be printed in the blank |
29 | spaces on the uniform claim form, and on subsequent pages if |
30 | necessary, by submitting a written request to the department. |
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1 | Such a request shall be deemed approved by the department if not |
2 | disapproved within sixty (60) days after receipt of the request. |
3 | A disapproval shall be subject to the procedures under 2 Pa.C.S. |
4 | (relating to administrative law and procedure). |
5 | (c.1) If, in a dental claim form, an insured specifically |
6 | authorizes payment of benefits directly to an entity or person |
7 | who provided dental services in accordance with the provisions |
8 | of the policy, the insurer shall make the payment to the |
9 | specified provider of the dental services. The insurance |
10 | contract may not prohibit, and claim forms must provide an |
11 | option for, the payment of benefits directly to the specified |
12 | provider of the dental services. The insurer may require written |
13 | attestation of the assignment of the payment. Payment to the |
14 | specified provider of the dental services from the insurer may |
15 | not be more than the amount that the insurer would otherwise |
16 | have paid without the assignment of payment. |
17 | (d) In the case of vision and dental claim forms and in the |
18 | case of supplemental major medical claim forms, utilization of |
19 | the uniform claim form shall be at the discretion of the |
20 | individual insurer. |
21 | Section 2. This act shall take effect in 60 days. |
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