THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY MURT, BELFANTI, CALTAGIRONE, CLYMER, DALEY, EVERETT, GINGRICH, GROVE, HARHART, McILVAINE SMITH, VULAKOVICH AND WHITE, MAY 12, 2010

REFERRED TO COMMITTEE ON INSURANCE, MAY 12, 2010  

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," further providing for forms for

health insurance claims.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Section 1202 of the act of May 17, 1921 (P.L.682,

No.284), known as The Insurance Company Law of 1921, added

December 15, 1992 (P.L.1129, No.148), is amended to read:

Section 1202.  Forms for Health Insurance Claims.--(a)  Each

health insurance claim form processed or otherwise used by an

insurer, including those used by the Department of Public

Welfare for public health care coverage, shall be the uniform

claim form developed by the department. The claim form shall be

identical in form and content except as provided in [subsection

(c)] subsections (c) and (c.1). The department shall, in

consultation with the Department of Public Welfare, insurers and

health care providers or their representatives, first consider

the feasibility of utilizing the UB-82/HCFA-1450 and HCFA-1500

forms, or their successors, as a uniform claim form. If these

forms are deemed to be unsatisfactory, the department shall, in

consultation with the Department of Public Welfare, insurers and

health care providers or their representatives, develop a

uniform claim form for use by all insurers, the Department of

Public Welfare's public health care coverage program and health

care providers. The uniform claim form shall contain blank

spaces at appropriate places in the document for approved

additional information requests under subsection (c).

(b)  The feasibility study and subsequent development of the

uniform claim form shall be complete within one hundred eighty

(180) days of the effective date of this article. All insurers,

the Department of Public Welfare's public health care coverage

program and health care providers shall be required to use the

uniform claim form within one hundred twenty (120) days after

the uniform claim form is developed. The department may consider

a request from the Department of Public Welfare for an extension

in meeting the implementation schedule of this section.

(c)  (1)  Subject to the procedure contained in clause (2),

an insurer may request that a claimant provide departmentally

approved additional information which is not requested on the

uniform claim form.

(2)  An insurer may request departmental approval of

additional information requests to be printed in the blank

spaces on the uniform claim form, and on subsequent pages if

necessary, by submitting a written request to the department.

Such a request shall be deemed approved by the department if not

disapproved within sixty (60) days after receipt of the request.

A disapproval shall be subject to the procedures under 2 Pa.C.S. 

(relating to administrative law and procedure).

(c.1)  If, in a health insurance claim form, an insured

specifically authorizes payment of benefits directly to an

entity or person who provided health care services in accordance

with the provisions of the policy, the insurer shall make the

payment to the specified provider of the health care services.

The insurance contract may not prohibit, and claim forms must

provide an option for, the payment of benefits directly to the

specified provider of the health care services. The insurer may

require written attestation of the assignment of the payment.

Payment to the specified provider of the health care services

from the insurer may not be more than the amount that the

insurer would otherwise have paid without the assignment of

payment.

(d)  In the case of vision and dental claim forms and in the

case of supplemental major medical claim forms, utilization of

the uniform claim form shall be at the discretion of the

individual insurer.

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