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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY BAKER, MICOZZIE, CUTLER, GINGRICH, BOBACK, CAUSER, CLYMER, DENLINGER, EVERETT, GABLER, GEIST, GOODMAN, KAUFFMAN, MOUL, MURT, OBERLANDER, PICKETT, REICHLEY, SWANGER, TALLMAN AND VULAKOVICH, JUNE 18, 2009 |
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| REFERRED TO COMMITTEE ON INSURANCE, JUNE 18, 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," providing for foreign health |
12 | insurance. |
13 | The General Assembly of the Commonwealth of Pennsylvania |
14 | hereby enacts as follows: |
15 | Section 1. The act of May 17, 1921 (P.L.682, No.284), known |
16 | as The Insurance Company Law of 1921, is amended by adding an |
17 | article to read: |
18 | ARTICLE XXVI |
19 | FOREIGN HEALTH INSURANCE |
20 | Section 2601. Definitions. |
21 | The following words and phrases when used in this article |
22 | shall have the meanings given to them in this section unless the |
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1 | context clearly indicates otherwise: |
2 | "Commissioner." The Insurance Commissioner of the |
3 | Commonwealth. |
4 | "Covered person." An individual who is entitled to health |
5 | care services provided, arranged for, paid for or reimbursed |
6 | under a health benefits plan. |
7 | "Domestic health insurer." An insurer licensed to sell, |
8 | offer or provide health benefits plans in this Commonwealth. |
9 | "Foreign health insurer." An insurer licensed to sell, offer |
10 | or provide health benefits plans in any other state. |
11 | "Hazardous financial condition." A condition in which a |
12 | foreign health insurer is unlikely to be able to meet |
13 | obligations to policyholders with respect to known claims or to |
14 | any other obligations in the normal course of business, based on |
15 | its present or reasonably anticipated financial status. |
16 | "Health benefits plan." An arrangement for the delivery of |
17 | health care, on an individual or group basis, in which a health |
18 | carrier undertakes to provide, arrange for, pay for or reimburse |
19 | any of the costs of health care services for a covered person |
20 | that is offered in accordance with the laws of any state. The |
21 | term does not include any of the following: |
22 | (1) Short-term travel, accident only, limited or |
23 | specified disease or individual conversion policies or |
24 | contracts. |
25 | (2) Policies or contracts designed for issuance to |
26 | persons eligible for coverage under Title XVIII of the Social |
27 | Security Act (49 Stat. 620, 42 U.S.C. § 1395 et seq.). |
28 | (3) Any other coverage, similar to that listed under |
29 | paragraph (1) or (2), under Federal or State governmental |
30 | plans. |
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1 | "Provider" or "health care provider." Any hospital, |
2 | physician, or other person authorized by statute, licensed or |
3 | certified to furnish health care services. |
4 | "Resident." An individual whose primary residence is in this |
5 | Commonwealth and who is present in this Commonwealth for at |
6 | least six months of the calendar year. |
7 | Section 2602. Out-of-State carriers' provision of coverage. |
8 | Notwithstanding any other law or regulation, a foreign health |
9 | insurer may sell, offer and provide a health benefits plan to |
10 | residents in this Commonwealth if that insurer does all of the |
11 | following: |
12 | (1) Offers the health benefit plan in its domiciliary |
13 | state and is in compliance with all applicable laws, |
14 | regulations and requirements of its domiciliary state. |
15 | (2) Obtains a certificate of authority to do business as |
16 | a foreign health insurer in this Commonwealth. |
17 | (3) Complies with all laws and regulations of this State |
18 | enacted for the benefit of health insurance consumers. |
19 | (4) Is not required to offer the health benefits |
20 | mandated by the laws or regulations of this Commonwealth, or |
21 | comply with any law regarding rate regulation. |
22 | Section 2603. Certificate of authority. |
23 | (a) Application.--A foreign health insurer may apply for a |
24 | certificate that authorizes the foreign health insurer to do |
25 | business as a foreign health insurer in this Commonwealth using |
26 | a form prescribed by the commissioner. Upon application, the |
27 | commissioner shall issue a certificate to the foreign health |
28 | insurer unless the commissioner determines that the foreign |
29 | health insurer meets any of the following: |
30 | (1) Will not provide a health benefits plan in |
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1 | compliance with the provisions of this article. |
2 | (2) Is in a hazardous financial condition, as determined |
3 | by an examination by the commissioner conducted in accordance |
4 | with the Financial Analysis Handbook of the National |
5 | Association of Insurance Commissioners. |
6 | (3) Has not adopted procedures to ensure compliance with |
7 | all applicable laws governing the confidentiality of its |
8 | records with respect to providers and covered persons. |
9 | (b) Validity.--A certificate of authority issued under this |
10 | section shall be valid for three years from the date of issuance |
11 | by the commissioner. The commissioner shall, by regulation, |
12 | establish all of the following: |
13 | (1) Procedures for a foreign health insurer to renew a |
14 | certificate of authority under this article. |
15 | (2) Certificate of authority application and renewal |
16 | fees, the amount of which shall be no greater than is |
17 | reasonably necessary to enable the commissioner to carry out |
18 | the provisions of this article. |
19 | Section 2604. Required disclosures. |
20 | (a) Contents.--Each health benefits plan and each |
21 | application for a health benefits plan provided by a foreign |
22 | health insurer to a resident shall disclose all of the following |
23 | in plain language: |
24 | (1) The differences between the benefits of the health |
25 | benefits plan issued by the foreign health insurer and a |
26 | health benefits plan issued under the laws of this |
27 | Commonwealth. |
28 | (2) The differences that relate to mandated health |
29 | benefits, underwriting standards, premium rating, preexisting |
30 | conditions, renewability, portability and cancellation. |
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1 | (3) That the health benefits plan is primarily governed |
2 | by the laws of the foreign health insurer's domicile and |
3 | therefore all of the rating laws applicable to individual or |
4 | group accident and health insurance filed in this |
5 | Commonwealth do not apply to the health benefits plan, which |
6 | may result in increases to the insurance premium at the time |
7 | of renewal that would not be permissible with a health |
8 | benefits plan governed by the laws of this Commonwealth. |
9 | (4) That any purchase of health insurance should be |
10 | considered carefully since future medical conditions may make |
11 | it impossible to qualify for another health benefits plan. |
12 | (5) That although the health benefits plan may provide |
13 | more affordable health coverage, the following apply: |
14 | (i) The health benefits plan may also provide fewer |
15 | health benefits than those normally included as State- |
16 | mandated health insurance policies issued by domestic |
17 | health insurers. |
18 | (ii) The insured's insurance agent should be |
19 | consulted to determine which State-mandated health |
20 | benefits are excluded under the policy. |
21 | Section 2605. Powers and duties of the commissioner. |
22 | (a) Powers.--The commissioner may do all of the following: |
23 | (1) After notice and opportunity to be heard, deny, |
24 | revoke or suspend a certificate of authority issued to a |
25 | foreign health insurer for any violation of this article. The |
26 | commissioner shall provide for an appropriate and timely |
27 | right of appeal for a foreign health insurer whose |
28 | certificate of authority is denied, revoked or suspended. |
29 | (2) Conduct market conduct and solvency examinations of |
30 | an existing or prospective foreign health insurer. The market |
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1 | conduct and solvency examinations shall be conducted in the |
2 | same manner and under the same terms and conditions as an |
3 | examination of an insurer located in this State. |
4 | (b) Duties.-- |
5 | (1) The commissioner shall establish procedures for the |
6 | review of claims and grievances filed by a health care |
7 | provider or a covered individual, marketing materials |
8 | proposed by a foreign health insurer to market a health |
9 | benefit plan to residents or employers in this State and the |
10 | application and health benefit plan of a prospective foreign |
11 | health insurer. |
12 | (2) The commissioner shall adopt rules to administer |
13 | this article. The rules shall not do any of the following: |
14 | (i) Require the foreign health insurer to modify |
15 | coverage or benefit requirements or restrict underwriting |
16 | requirements or premium ratings in a manner that |
17 | conflicts with the laws or regulations of a foreign |
18 | health insurer's domiciliary state. |
19 | (ii) Provide for an expansion of the commissioner's |
20 | authority over foreign health insurers in a way that |
21 | conflicts with this article. |
22 | Section 2. This act shall take effect in 60 days. |
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