Bill Text: PA HB265 | 2011-2012 | Regular Session | Introduced

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Bill Title: Providing for small employer group health plans.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2011-01-26 - Referred to INSURANCE [HB265 Detail]

Download: Pennsylvania-2011-HB265-Introduced.html

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PRINTER'S NO. 213
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 265 Session of2011
INTRODUCED BY DePASQUALE, MURPHY, DeLUCA, BURNS, GEORGE, BAKER, BARRAR, BEAR, BOYD, B. BOYLE, BUXTON, CALTAGIRONE, CARROLL, CLYMER, COHEN, D. COSTA, CUTLER, J. EVANS, EVERETT, FABRIZIO, FLECK, FRANKEL, FREEMAN, GEIST, GILLESPIE, GOODMAN, GROVE, HALUSKA, HARKINS, HESS, HORNAMAN, HUTCHINSON, JOSEPHS, KORTZ, KULA, LONGIETTI, MAJOR, MANN, MARSHALL, MILLARD, MILLER, MIRABITO, MOUL, MULLERY, MUNDY, O'NEILL, PASHINSKI, PAYTON, PETRARCA, PICKETT, PYLE, READSHAW, REICHLEY, SABATINA, SANTARSIERO, SANTONI, SCAVELLO, SCHRODER, K. SMITH, M. SMITH, STABACK, STURLA, SWANGER, TALLMAN, VULAKOVICH, WATSON, WHITE, YOUNGBLOOD, M. O'BRIEN, WAGNER AND BRADFORD, JANUARY 26, 2011
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 26, 2011
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," providing for small employer group
health plans.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding an
article to read:
ARTICLE XL
Small employer
group HEALTH PLANS
Section 4001. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Eligible employee." A person employed by a small employer
on a regularly scheduled basis, with a normal work week of 17.5
hours or more. The term does not include persons who work on a
temporary, seasonal or substitute basis.
"Health benefit plan." Any individual or group health
insurance policy, subscriber contract, certificate or plan which
provides health or sickness and accident coverage which is
offered by an insurer. The term shall not include any of the
following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A long-term care policy.
(5) A specified disease policy.
(6) A Medicare supplement policy.
(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).
(13) Any other similar policies providing for limited
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benefits.
"Insurer." A company or health insurance entity licensed in
this Commonwealth to issue any individual or group health,
sickness or accident policy or subscriber contract or
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 this act or any of
the following:
(1) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(2) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(4) Article XXIV.
"Plan year." The 12-consecutive-month period beginning on
the first day of coverage under a health benefit plan.
"Small employer." In connection with a group health plan
with respect to a calendar year and a plan year, an employer who
employs an average of at least two but not more than 50 eligible
employees on business days during the preceding calendar year
and who employs at least two eligible employees on the first day
of the plan year. In the case of an employer which was not in
existence throughout the preceding calendar year, the
determination whether an employer is a small employer shall be
based on the average number of eligible employees that it is
reasonably expected that the employer will employ on business
days in the current calendar year.
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"Small group health benefit plan." A health benefit plan
offered to a small employer.
Section 4002. Small employer groups.
(a) Formation authority.--A group of two or more small
employers may form a purchasing group for the purpose of
purchasing a small group health benefit plan provided for under
this article from an insurer.
(b) Certification.--No insurance policy may be issued,
delivered or renewed to a purchasing group unless that
purchasing group has a valid certification from the department.
(c) Regulations.--The department may promulgate regulations,
including certification requirements, as necessary for the
implementation and administration of this section.
(d) Minimum number in group.--The regulations may establish
a minimum number of small employers that may form and
participate in a purchasing group. The regulations may also
provide that individuals may participate in a purchasing group.
(e) Certification subject to criteria.--Unless certification
requirements are promulgated, certification under this section
shall be subject to the criteria set forth in section 621.2(a)
(5.1).
(f) Applicability.--The provisions of this section shall
apply notwithstanding the provisions of section 621.2(a)(2).
Section 4003. Enforcement.
(a) Determination of violation.--Upon a determination that a
person licensed by the department has violated any provision of
this article, the commissioner may, subject to 2 Pa.C.S. Chs. 5
Subch. A (relating to practice and procedure of Commonwealth
agencies) and 7 Subch. A (relating to judicial review of
Commonwealth agency action), do any of the following:
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(1) Issue an order requiring the person to cease and
desist from engaging in the violation.
(2) Suspend or revoke or refuse to issue or renew the
certificate or license of the offending party or parties.
(3) Impose an administrative penalty of up to $5,000 for
each violation.
(4) Seek restitution.
(b) Other remedies.--The enforcement remedies imposed under
this section shall be in addition to any other remedies or
penalties that may be imposed by any other statute, including
the act of July 22, 1974 (P.L.589, No.205), known as the Unfair
Insurance Practices Act. A violation by any person of this
article is deemed an unfair method of competition and an unfair
or deceptive act or practice under the Unfair Insurance
Practices Act.
Section 2. This act shall take effect in 60 days.
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