PRINTER'S NO. 364
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
373
Session of
2017
INTRODUCED BY EICHELBERGER, GREENLEAF, REGAN, RAFFERTY, COSTA,
BREWSTER, BROWNE, ARGALL, MENSCH, WARD, VOGEL AND BOSCOLA,
FEBRUARY 15, 2017
REFERRED TO BANKING AND INSURANCE, FEBRUARY 15, 2017
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," in uniform health insurance claim
form, 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, 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] Human Services for public health care coverage, shall
be the uniform claim form developed by the department. The claim
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form shall be identical in form and content except as provided
in subsection (c). The department shall, in consultation with
the Department of [Public Welfare] Human Services, 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] Human
Services, insurers and health care providers or their
representatives, develop a uniform claim form for use by all
insurers, the Department of [Public Welfare's] Human Services'
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] Human Services' 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] Human Services 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
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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).
(3) If, in a dental claim form, an insured specifically
authorizes payment of benefits directly to an entity or person
who provided dental services in accordance with the provisions
of the policy, the insurer shall make the payment to the
specific provider of the dental 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 dental service. The insurer may require written attestation
of the assignment of the payment. Payment to the specific
provider of the dental 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.
(e) The Legislative Budget and Finance Committee shall
conduct a study to examine all of the following:
(1) The costs and benefits associated with the direct
reimbursement of nonparticipating providers by health insurance
carriers under a valid agreement of benefits.
(2) The impact on consumers of prohibiting health insurance
carriers from refusing to accept a valid assignment of benefits.
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(3) The impact of requiring direct reimbursement of
nonparticipating providers by health insurance carriers on a
health insurance carrier's ability to maintain an adequate
number of providers in their network. A report on the study
shall be presented to the chairman and minority chairman of the
Insurance Committee of the House of Representatives and the
chairman and minority chairman of the Banking and Insurance
Committee of the Senate no more than thirty-six months after the
effective date of this subsection.
Section 2. This act shall take effect in 60 days.
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