THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY O'NEILL, BRIGGS, BUXTON, CAUSER, CLYMER, CUTLER, DENLINGER, EVERETT, FARRY, HARHART, HARKINS, HORNAMAN, KAVULICH, M.K. KELLER, W. KELLER, LONGIETTI, MARSHALL, MILLARD, MILLER, MOUL, MURT, PAYNE, RAPP, READSHAW, SCAVELLO, SWANGER, TALLMAN, VEREB, WAGNER, WATSON, WILLIAMS AND FABRIZIO, FEBRUARY 2, 2011

REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 2, 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," prohibiting discrimination against

volunteer ambulance services.

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 a

section to read:

Section 635.6.  Discrimination Against Volunteer Ambulance

Services Prohibited.--(a)  An insurer shall be required to

contract with and to accept as a participating provider any

willing provider of volunteer ambulance services. An insurer

shall not discriminate against a provider of volunteer ambulance

services who agrees to accept negotiated payment levels and to

adhere to quality standards established by the insurer.

(b)  Whenever a volunteer ambulance service is properly

dispatched by a public safety answering point as defined in the

act of July 9, 1990 (P.L.340, No.78), known as the "Public

Safety Emergency Telephone Act," any payment made by an insurer

for a claim covered under a health insurance policy for a

service performed by the volunteer ambulance service during such

call shall be paid directly to the volunteer ambulance service,

regardless of whether the ambulance service is a participating

provider with the insurer.

(c)  The following shall apply:

(1)  An insured may, through the assignment of benefits,

assign to a willing provider of volunteer ambulance services his

right to receive reimbursement for any service performed by a

volunteer ambulance service.

(2)  A volunteer ambulance service provided an assignment of

benefits by an insured shall submit a copy of that assignment or

provide a notice of the assignment of benefits on a form and in

a manner prescribed by the department to the insurer with any

claim for payment for any ambulance service performed by the

volunteer ambulance service.

(3)  The insurer, based upon the claim and notice of the

assignment of benefits submitted by the volunteer ambulance

service, shall remit payment of the claim directly to the

volunteer ambulance service within the time frame established by

this act for remitting payment on a claim and provide written

notice, within the same applicable time frame, of the payment to

the insured.

(4)  If the insured executes an assignment of benefits and

the volunteer ambulance service submits notice of that

assignment of benefits with its claim for payment pursuant to

paragraph (2), but the insurer remits payment of the claim to

the insured, the claim shall not be considered paid. The insurer

shall, notwithstanding the incorrect payment of the claim to the

insured, remain liable for remitting payment of the claim to the

volunteer ambulance service pursuant to the assignment of

benefits.

(d)  As used in this section:

(1)  "Insurer" means an entity that is responsible for

providing or paying for all or part of the cost of ambulance

services covered by an insurance policy, contract or plan other

than a homeowner's insurance policy. An insurer includes an

entity subject to:

(i)  This act.

(ii)  The act of December 29, 1972 (P.L.1701, No.364), known

as the "Health Maintenance Organization Act."

(iii)  40 Pa.C.S. Ch. 61 (relating to hospital plan

corporations) or 63 (relating to professional health services

plan corporations).

(2)  For purposes of the definition of "insurer" as provided

under paragraph (1), an "insurance policy, contract or plan"

shall not include the following types of insurance or any

combination thereof: accident only, fixed indemnity, limited

benefit, credit, dental, vision, specified disease, Medicare

supplement, Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS) supplement, long-term care or disability

income, workers' compensation or automobile medical payment

insurance.

(3)  "Volunteer ambulance service" means any nonprofit

chartered corporation, association or organization located in

this Commonwealth, which is licensed by the Department of Health

and is not associated or affiliated with any hospital and which

is regularly engaged in the provision of emergency medical

services, including basic life support or advanced life support

services and the transportation of patients within this

Commonwealth.

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