PRINTER'S NO. 397
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
360
Session of
2015
INTRODUCED BY READSHAW, COHEN, KORTZ, KINSEY, KOTIK, MATZIE,
BARRAR, METZGAR, HARKINS, HARHAI, TALLMAN, D. COSTA, MAHONEY,
GOODMAN, FEE, GILLEN, O'NEILL, DEASY AND MURT,
FEBRUARY 9, 2015
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 9, 2015
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 635.7. 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
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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 under
35 Pa.C.S. ยง 5302 (relating to definitions), 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
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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).
For purposes of this definition, an "insurance policy, contract
or plan" does 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.
(2) " Volunteer ambulance service " means any nonprofit
chartered corporation, association or organization located in
this Commonwealth, which is licensed by the Department of Health
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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.
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