THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY MATZIE, BARBIN, D. COSTA, SABATINA, BRIGGS, CALTAGIRONE, DEASY, FABRIZIO, GIBBONS, HORNAMAN, JOHNSON, JOSEPHS, KORTZ, KOTIK, KULA, MUNDY, MURT, M. O'BRIEN, READSHAW, ROSS, K. SMITH, STABACK, STURLA, THOMAS, WAGNER AND YOUNGBLOOD, FEBRUARY 16, 2011

REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 16, 2011  

AN ACT

Amending the act of April 9, 1929 (P.L.177, No.175), entitled

"An act providing for and reorganizing the conduct of the

executive and administrative work of the Commonwealth by the

Executive Department thereof and the administrative

departments, boards, commissions, and officers thereof,

including the boards of trustees of State Normal Schools, or

Teachers Colleges; abolishing, creating, reorganizing or

authorizing the reorganization of certain administrative

departments, boards, and commissions; defining the powers and

duties of the Governor and other executive and administrative

officers, and of the several administrative departments,

boards, commissions, and officers; fixing the salaries of the

Governor, Lieutenant Governor, and certain other executive

and administrative officers; providing for the appointment of

certain administrative officers, and of all deputies and

other assistants and employes in certain departments, boards,

and commissions; and prescribing the manner in which the

number and compensation of the deputies and all other

assistants and employes of certain departments, boards and

commissions shall be determined," establishing the Office of

Consumer Advocate for Health Insurance as an office within

the Office of Consumer Advocate and prescribing its powers

and duties; and making editorial changes.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Article IX-A of the act of April 9, 1929 (P.L.

177, No.175), known as The Administrative Code of 1929, is

amended by adding a subarticle heading to read:

ARTICLE IX-A

OFFICE OF CONSUMER ADVOCATE

(a)  General Provisions

Section 2.  Article IX-A of the act is amended by adding a

subarticle to read:

(b)  Office of Consumer Advocate

for Health Insurance

Section 921-A.  Definitions.

The following words and phrases when used in this subarticle

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Consumer."  A person who is a named insured, insured or

beneficiary of a policy of health insurance or any other person,

including employers who purchase insurance for themselves and

their employees, who may be affected in any way by the Insurance

Department's exercise of or the failure to exercise its

authority.

"Department."  The Insurance Department of the Commonwealth.

"Insurer."  Any "company," "association" or "exchange" as

such terms are defined in section 101 of the act of May 17, 1921

(P.L.682, No.284), known as The Insurance Company Law of 1921 or

any entity subject to 40 Pa.C.S. Ch. 61 (relating to hospital

plan corporations) or 63 (relating to professional health

services plan corporations) or Article XXIV of The Insurance

Company Law of 1921 or the act of December 29, 1972 (P.L.1701,

No.364), known as the Health Maintenance Organization Act.

Section 922-A.  Office of Consumer Advocate for Health

Insurance.

(a)  Office established.--There is hereby established as an

office within the Department of Community and Economic

Development an Office of Consumer Advocate for Health Insurance

to represent the interests of consumers before the department.

(b)  Consumer Advocate for Health Insurance.--The Office of

Consumer Advocate for Health Insurance shall be headed by the

Consumer Advocate for Health Insurance appointed by the Governor

who by reason of training, experience and attainment is

qualified to represent the interests of consumers. The term of

the Consumer Advocate shall be for six years, and no person

shall serve for more than two terms. Compensation shall be set

by the Executive Board, established under section 204.

(c)  Conflict of interest.--No individual who serves as a

Consumer Advocate for Health Insurance shall, while serving in

the position, engage in any business, vocation or other

employment, or have other interests, inconsistent with the

official responsibilities, nor shall the individual seek or

accept employment nor render beneficial services for

compensation with any insurer subject to the authority of the

office during the tenure of the appointment and for a period of

two years immediately after the appointment is served or

terminated.

(d)  Restriction.--Neither the Consumer Advocate for Health

Insurance nor an employee of the Consumer Advocate shall be

employed by or be pecuniarily interested in any insurance

company, association or exchange, or in any insurance business,

other than as a policyholder.

(e)  Political office.--Any individual who is appointed to

the position of Consumer Advocate for Health Insurance shall not

seek election nor accept appointment to any political office

during the tenure as Consumer Advocate for Health Insurance and

for a period of two years after the appointment is served or

terminated.

Section 923-A.  Assistant consumer advocates for health

insurance; employees.

The Consumer Advocate for Health Insurance may appoint

attorneys as assistant consumer advocates for health insurance

and additional clerical, technical and professional staff as may

be appropriate, and may contract for additional services as

shall be necessary for the performance of the duties imposed by

this subarticle. The compensation of assistant consumer

advocates for health insurance and clerical, technical and

professional staff shall be set by the Executive Board. No

assistant consumer advocate for health insurance or other staff

employee shall, while serving in the position, engage in any

business, vocation or other employment, or have other interests,

inconsistent with official responsibilities.

Section 924-A.  Powers and duties of Consumer Advocate for

Health Insurance.

(a)  Representation of consumer interests.--In addition to

any other authority conferred by this subarticle, the Consumer

Advocate for Health Insurance is authorized to and shall, in

carrying out the responsibilities under this subarticle,

represent the interests of consumers as a party, or otherwise

participate for the purpose of representing an interest of

consumers, before the department in any matter properly before

the department, and before any court or agency, initiating

proceedings if, in the judgment of the Consumer Advocate for

Health Insurance, the representation may be necessary, in

connection with any matter involving regulation by the

department or the corresponding regulatory agency of the United

States, whether on appeal or otherwise initiated.

(b)  Exercise of discretion.--The Consumer Advocate for

Health Insurance may exercise discretion in determining the

interests of consumers that will be advocated in any particular

proceeding and in determining whether to participate in or

initiate any particular proceeding. In making a determination,

the Consumer Advocate for Health Insurance shall consider the

public interest, the resources available and the substantiality

of the effect of the proceeding on the interests of consumers.

The Consumer Advocate for Health Insurance may refrain from

intervening when, in the judgment of the Consumer Advocate for

Health Insurance, intervention is not necessary to represent

adequately the interests of consumers.

(c)  Grants.--The Consumer Advocate for Health Insurance

shall apply for all grant moneys available from the Federal

Government through the Patient Protection and Affordable Care

Act (Public Law 111-148, 124 Stat. 119) and other related laws

and may expend all the moneys obtained from grant awards.

(d)  Action on petition.--In addition to any other authority

conferred by this subarticle, the Consumer Advocate for Health

Insurance is authorized to represent an interest of consumers

that is presented for consideration upon petition in writing by

a substantial number of persons who are consumers of an insurer

subject to regulation by the department. The Consumer Advocate

for Health Insurance shall notify the principal sponsors of the

petition within a reasonable time after receipt of the petition

of the action taken or intended to be taken with respect to the

interests of consumers presented in that petition. If the

Consumer Advocate for Health Insurance declines or is unable to

represent the interests, written notification and the reasons

for the action shall be given to the sponsors.

(e)  Name in which action is brought.--Any action brought by

the Consumer Advocate for Health Insurance before a court or an

agency of this Commonwealth shall be brought in the name of the

Consumer Advocate for Health Insurance. The Consumer Advocate

for Health Insurance may name a consumer or group of consumers

in whose name the action may be brought or may join with a

consumer or group of consumers in bringing the action.

(f)  Public statement.--At a time that the Consumer Advocate

for Health Insurance determines, in accordance with applicable

time limitations, to initiate, intervene or otherwise

participate in any department, agency or court proceeding, the

Consumer Advocate for Health Insurance shall issue publicly a

written statement, a copy of which shall be filed in the

proceeding in addition to any required entry of appearance,

stating concisely the specific interests of consumers to be

protected.

Section 925-A.  Duties of department.

In dealing with any proposed action that may substantially

affect the interests of consumers, including, but not limited

to, a proposed change of rates and the adoption of rules,

regulations, guidelines, orders, standards or final policy

decisions, the department shall:

(1)  Notify the Consumer Advocate for Health Insurance

when notice of the proposed action is given to the public or

at a time fixed by agreement between the Consumer Advocate

for Health Insurance and the department in a manner to assure

the Consumer Advocate for Health Insurance reasonable notice

and adequate time to determine whether to intervene in the

matter.

(2)  Consistent with its other statutory

responsibilities, take action with due consideration to the

interests of consumers.

Section 926-A.  Reports.

The Consumer Advocate for Health Insurance shall annually

transmit to the Governor and to the General Assembly, and shall

make available to the public, an annual report on the conduct of

the Office of Consumer Advocate for Health Insurance. The

Consumer Advocate for Health Insurance shall make

recommendations as may from time to time be necessary or

desirable to protect the interests of consumers.

Section 927-A.  Savings provision and construction.

(a)  No bar to action.--Nothing contained in this subarticle

shall limit the right of a consumer to bring a proceeding before

either the department or a court.

(b)  No impairment to department.--Nothing contained in this

subarticle shall be construed to impair the statutory authority

or responsibility of the department to regulate insurers in the

public interest.

Section 3.  This act shall take effect in 60 days.