THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY GREENLEAF, FONTANA, BROWNE, RAFFERTY, EARLL AND O'PAKE, JANUARY 20, 2009

REFERRED TO BANKING AND INSURANCE, JANUARY 20, 2009  

AN ACT

Requiring the Insurance Department to develop various

standardized basic health insurance plans that insurers may

offer to individuals and small employers; and providing for

the filing of rates by insurers and for disclosure statement.

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 Basic Health

Insurance Plans for Pennsylvanians Act.

Section 2.  Statement of purpose.

The General Assembly recognizes the need for individuals,

employers and other purchasers of health insurance coverage in

this Commonwealth to have the opportunity to choose health

insurance plans that are more affordable and flexible than

existing market policies offering health insurance coverage.

Therefore, the General Assembly seeks to increase the

availability of health insurance coverage by having the

Insurance Department develop several basic health insurance

plans which insurers may offer that, in whole or in part, do not

offer or provide State-mandated health benefits.

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:

"Basic health insurance plans."  One of ten standardized

health insurance policies called "A" through "J" which the

Insurance Department develops and insurers may offer to a

qualified individual and small employer that, in whole or in

part, do not offer or provide State-mandated health benefits.

"Commissioner."  The Insurance Commissioner of the

Commonwealth.

"Department."  The Insurance Department of the Commonwealth.

"Dependent child."  A natural or adopted child of an

employee. The term includes a stepchild who resides in an

employee's household if the employee 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 an employee and a

dependent child who is under 19 years of age.

"Insurer."  An insurer, health maintenance organization,

fraternal benefit society, hospital plan or health services plan

corporation that offers basic small group insurance plans to

small employers.

"Qualified individual."  A person employed by a small

employer who is an active employee or eligible dependent or who

is self-employed.

"Small employer."  A person, firm, corporation, partnership

or association that employed, on at least 50% of its working

days during the preceding year, at least two but not more than

100 employees.

Section 4.  Basic health insurance plans.

(a)  Development of standard plans.--The department shall

develop ten standard basic health insurance plans named "A"

through "J" that insurers may offer to a qualified individual

and small employer.

(b)  Waiver of State mandates.--No law requiring the coverage

of a health care benefit or service or requiring the

reimbursement, utilization or inclusion of a specific category

of licensed health care practitioners shall apply to basic

health insurance plans delivered or issued for delivery in this

Commonwealth.

(c)  Benefit plans.--In developing the ten standard basic

health insurance plans, the department must ensure that each

standardized plan covers basic or core benefits and has a

different set of benefits. All plans with the same letter shall

cover the same benefits. Plan A shall cover only the basic or

core benefits and Plan J shall cover the most benefits.

(d)  Copayment and deductibles.--The department may establish

a copayment or deductible for each of the basic health insurance

plans.

Section 5.  Offering and rate filing of basic health insurance

plans.

(a)  Offering.--Insurers may offer, as an option, one or more

of the basic health insurance plans developed by the department

to a qualified individual and small employer.

(b)  Filing.--Insurers must file their rates with the

department for approval by the commissioner for each basic

health insurance plan that they intend to deliver or issue for

delivery to any qualified individual and small employer in this

Commonwealth.

(c)  Additional coverage.--Insurers may offer benefits in

addition to those offered under the basic health insurance plans

and charge an additional premium accordingly.

Section 6.  Disclosure statement.

(a)  Written disclosure.--When an insurer issues a basic

health insurance plan policy, the insurer shall provide an

applicant or subscriber of the basic health insurance plan with

a written disclosure statement in a form and manner required by

rule or regulation promulgated by the commissioner that:

(1)  Acknowledges that the basic health insurance plan

being purchased does not provide some or all State-mandated

health benefits.

(2)  Lists those State-mandated health benefits not

included under the basic health insurance plan.

(3)  Includes a section that allows for a signature by

the applicant or subscriber attesting to the fact that the

applicant or subscriber has read and understood the

disclosure statement.

(b)  Return of disclosure.--

(1)  Each applicant and subscriber for initial coverage

of a basic health insurance plan must sign the disclosure

statement provided by the insurer under subsection (a) and

return the statement to the insurer.

(2)  Under a group policy or contract, the term

"applicant" means the employer and the term "subscriber"

means the employee. Under an individual policy or contract

"applicant" means the individual purchasing the policy.

(c)  Record retention.--An insurer must:

(1)  Retain the signed disclosure statement in the

insurer's records.

(2)  Provide the signed disclosure statement to the

department upon the request from the commissioner.

Section 7.  Additional policies.

An insurer that offers one or more basic health insurance

plans to a qualified individual and small employer must also

offer at least one health insurance policy that has been filed

and approved with the department and includes coverage for all

State-mandated health benefits. A small employer that offers a

basic health insurance plan to its eligible employees must offer

at least one health insurance policy that includes coverage for

all State-mandated health benefits that has been filed and

approved by the department.

Section 8.  Regulations.

The commissioner shall promulgate any rules and regulations

necessary to implement the provisions of this act.

Section 9.  Effective date.

This act shall take effect in 60 days.