Bill Text: PA HB134 | 2009-2010 | Regular Session | Introduced

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Bill Title: Requiring the Insurance Department to develop standard health benefit plans that certain insurers shall offer to individuals and small employers; and requiring the Insurance Department to facilitate the availability of standard health benefit plan information by electronic and other means.

Spectrum: Strong Partisan Bill (Republican 23-2)

Status: (Introduced - Dead) 2009-01-30 - Referred to INSURANCE [HB134 Detail]

Download: Pennsylvania-2009-HB134-Introduced.html

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PRINTER'S NO. 130
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 134 Session of2009
INTRODUCED BY KILLION, BARRAR, BOYD, CUTLER, ELLIS, GEIST, GROVE, HUTCHINSON, KIRKLAND, MILLARD, MILLER, MUSTIO, PICKETT, REICHLEY, ROSS, STERN, VULAKOVICH, WATSON, BEAR, FLECK, MARSHALL, MAJOR AND MILNE, JANUARY 30, 2009
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 30, 2009
AN ACT
Requiring the Insurance Department to develop standard health
benefit plans that certain insurers shall offer to
individuals and small employers; and requiring the Insurance
Department to facilitate the availability of standard health
benefit plan information by electronic and other means.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the LifeLine
Health Insurance Act.
Section 2. Statement of purpose.
The General Assembly finds and declares as follows:
(1) There is a need for individuals and employers in
this Commonwealth to have the opportunity to acquire health
benefit plans that provide appropriate and affordable
coverage.
(2) The Commonwealth should increase the availability of
coverage by specifying health benefit plans which certain
insurers shall offer and requiring the Insurance Department
to take steps to facilitate the availability of information
relating to the plans and their terms, conditions and
premiums through electronic and other means.
Section 3. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Department." The Insurance Department of the Commonwealth.
"Dependent child." A natural or adopted child of a qualified
individual. The term includes a stepchild who resides in a
qualified individual's household if the qualified individual has
assumed the financial responsibility for the child and another
parent is not legally responsible for the support and medical
expenses of the child.
"Eligible dependent." A spouse of a qualified individual and
any dependent children who are under 19 years of age.
"Health benefit plan." An individual or group health
insurance policy, subscriber contract, certificate or plan that
provides health or sickness and accident coverage which is
offered by an insurer. The term does not include any of the
following:
(1) An accident only policy.
(2) A limited benefit policy.
(3) A credit only policy.
(4) A long-term or disability income policy.
(5) A specified disease policy.
(6) A Medicare supplement policy.
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(7) A Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement policy.
(8) A fixed indemnity policy.
(9) A dental only policy.
(10) A vision only policy.
(11) A workers' compensation policy.
(12) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
"High deductible health plan." A health insurance policy
that would qualify as a high deductible health plan under
section 223(c)(2) of the Internal Revenue Code of 1986 (Public
Law 99-514, 26 U.S.C. § 223(c)(2)).
"Insurer." A company or health insurance entity licensed in
this Commonwealth to issue any individual or group health
insurance, sickness or accident policy, subscriber contract,
certificate or plan that provides medical or health care
coverage by a health care facility or licensed health care
provider that is offered or governed under any of the following:
(1) This act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"Licensee." An individual who is licensed by the Department
of State to provide professional health care services in this
Commonwealth.
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"LifeLine health plan." A health benefit plan that offers
the following, subject to the provisions of section 4:
(1) Twenty-one days of inpatient hospital surgical and
medical coverage per policy year.
(2) Coverage for four office visits for primary health
care services for covered services rendered by a licensee,
subject to a copayment for each visit of $10 for treatment of
injury or illness.
(3) Coverage for surgery and anesthesia.
(4) Coverage for emergency accident and medical
treatment.
(5) Coverage for diagnostic services up to $1,000 for
each policy year.
(6) Coverage for chemotherapy and radiation treatment.
(7) Coverage for maternity care.
(8) Coverage for newborn care for up to 31 days
following birth.
"Participating insurer." An insurer that offers health
benefit plans to groups or individuals and which has health
benefit plans in force covering in the aggregate at least
100,000 qualified individuals in this Commonwealth.
"Standard health benefit plan." The LifeLine health plan and
any high deductible health plan offered by participating
insurers to individuals and employers.
Section 4. Offering of standard health benefit plans.
(a) Offering of plans.--All participating insurers shall
offer the standard benefit plans specified under this act to
individuals and to employers for the benefit of individuals
employed by them.
(b) Inclusion in coverage.--
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(1) If coverage is provided to eligible dependents under
a LifeLine health plan, the coverage shall include dependent
children of the insured from the moment of birth and for
adopted dependent children with prior coverage from the date
of the interlocutory decree of adoption.
(2) The participating insurer may require that the
insured give notice to it of any newborn child within 90 days
following the birth of the child and of any adopted child
within 60 days of the date the insured has filed a petition
to adopt.
(c) Exclusion.--Participating insurers may exclude coverage
under a LifeLine health plan for an individual who has not been
covered by a health benefit plan for more than 30 days for up to
one year for medical conditions for which medical advice or
treatment was received by the individual during the 12 months
prior to the effective date of the individual's LifeLine health
plan policy.
(d) Applicability.--No law, regulation or administrative
directive requiring the coverage of a health care benefit or
service or requiring the reimbursement, utilization or inclusion
of a specific category of licensee shall apply to LifeLine
health plans delivered or issued for delivery in this
Commonwealth under the authority granted under this act,
including the provision of the benefits or requirements mandated
under Article VI-A of the act of May 17, 1921 (P.L.682, No.284),
known as The Insurance Company Law of 1921, or by regulations
promulgated under this act.
Section 5. Facilitation by the department of access to standard
health benefit plans and related information.
(a) Duty of department.--The department shall take all
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actions necessary to effectuate the provisions of this act so
that participating insurers are able to make standard benefit
plans available not later than 180 days following the effective
date of this section.
(b) Demonstration of coverage.--
(1) Each insurer shall, not more than 90 days after the
effective date of this section, demonstrate to the
commissioner all of the following:
(i) If it has health benefit plans in force covering
a sufficient number of individuals to qualify as a
participating insurer.
(ii) If qualified as a participating insurer, that
it has the capacity to issue standard health benefit
plans and provide information sufficient to permit the
department to discharge the responsibilities assigned to
it under subsection (d).
(iii) If qualified as a participating insurer, that
it has undertaken a process to make standard benefit
plans available not later than 180 days following the
effective date of this section.
(2) The commissioner shall notify an insurer of its
qualification as a participating insurer under this
subsection.
(c) Demonstration of capacity.--
(1) An insurer shall, within 30 days of first providing
coverage under health benefit plans to a sufficient number of
individuals to qualify as a participating insurer under this
act, demonstrate to the commissioner that:
(i) It has the capacity to issue standard health
benefit plans and provide information sufficient to
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permit the department to discharge the responsibilities
assigned to it under subsection (d).
(ii) It has undertaken a process to make standard
benefit plans available not later than 180 days following
provision of the information to the commissioner.
(2) The commissioner shall notify an insurer of its
qualification as a participating insurer under this
subsection.
(d) Facilitation.--The department shall facilitate the
availability of information relating to standard health benefit
plans by electronic and other means, inclusive of pricing and
benefit information and all other relevant information, so that
prospective purchasers of the plans have the ability to compare
benefits, terms, conditions and pricing among all participating
insurers.
(e) Provision of information.--Participating insurers shall
provide the department, at its request, with information
sufficient to enable it to discharge its responsibilities under
subsection (d).
Section 6. Records and reporting.
A participating insurer shall provide an annual report to the
department in a form prescribed by the department enumerating:
(1) The number of individuals covered under standard
health benefit plans, including coverage provided both
directly to individuals and through employers.
(2) The number of persons receiving coverage both under
LifeLine health benefit plans and through high deductible
health plans.
Section 7. Petition for exception.
(a) General rule.--An insurer may, after the third
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anniversary of its qualification as a participating insurer,
petition the commissioner to be relieved of the obligation to
offer LifeLine health plans under this act.
(b) Findings by commissioner.--The commissioner may grant
the petition if the commissioner finds that:
(1) The petitioner has used its commercially reasonable
best efforts to market and issue the coverage.
(2) Continuation of the efforts would not provide
LifeLine health plan coverage to a sufficient number of
individuals to justify continued efforts to market and issue
the coverage.
(c) Arrangements.--The commissioner shall, as a condition
for approving a petition described under subsection (a), require
that arrangements be made for the orderly disposition of
outstanding coverage.
Section 8. Effective date.
This act shall take effect in 60 days.
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