PRINTER'S NO. 75
No. 84 Session of 2005
INTRODUCED BY GREENLEAF, O'PAKE, ORIE, PIPPY, M. WHITE, GORDNER,
COSTA, RAFFERTY AND BOSCOLA, JANUARY 31, 2005
REFERRED TO BANKING AND INSURANCE, JANUARY 31, 2005
AN ACT
1 Requiring the Insurance Department to develop various
2 standardized basic health insurance plans that insurers may
3 offer to individuals and small employers; and providing for
4 the filing of rates by insurers and for disclosure statement.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 Section 1. Short title.
8 This act shall be known and may be cited as the Basic Health
9 Insurance Plans for Pennsylvanians Act.
10 Section 2. Statement of purpose.
11 The General Assembly recognizes the need for individuals,
12 employers and other purchasers of health insurance coverage in
13 this Commonwealth to have the opportunity to choose health
14 insurance plans that are more affordable and flexible than
15 existing market policies offering health insurance coverage.
16 Therefore, the General Assembly seeks to increase the
17 availability of health insurance coverage by having the
18 Insurance Department develop several basic health insurance
1 plans which insurers may offer that, in whole or in part, do not
2 offer or provide State-mandated health benefits.
3 Section 3. Definitions.
4 The following words and phrases when used in this act shall
5 have the meanings given to them in this section unless the
6 context clearly indicates otherwise:
7 "Basic health insurance plans." One of ten standardized
8 health insurance policies called "A" through "J" which the
9 Insurance Department develops and insurers may offer to a
10 qualified individual and small employer that, in whole or in
11 part, do not offer or provide State-mandated health benefits.
12 "Commissioner." The Insurance Commissioner of the
13 Commonwealth.
14 "Department." The Insurance Department of the Commonwealth.
15 "Dependent child." A natural or adopted child of an
16 employee. The term includes a stepchild who resides in an
17 employee's household if the employee has assumed the financial
18 responsibility for the child and another parent is not legally
19 responsible for the support and medical expenses of the child.
20 "Eligible dependent." A spouse of an employee and a
21 dependent child who is under 19 years of age.
22 "Insurer." An insurer, health maintenance organization,
23 fraternal benefit society, hospital plan or health services plan
24 corporation that offers basic small group insurance plans to
25 small employers.
26 "Qualified individual." A person employed by a small
27 employer who is an active employee or eligible dependent or who
28 is self-employed.
29 "Small employer." A person, firm, corporation, partnership
30 or association that employed, on at least 50% of its working
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1 days during the preceding year, at least two but not more than
2 100 employees.
3 Section 4. Basic health insurance plans.
4 (a) Development of standard plans.--The department shall
5 develop ten standard basic health insurance plans named "A"
6 through "J" that insurers may offer to a qualified individual
7 and small employer.
8 (b) Waiver of State mandates.--No law requiring the coverage
9 of a health care benefit or service or requiring the
10 reimbursement, utilization or inclusion of a specific category
11 of licensed health care practitioners shall apply to basic
12 health insurance plans delivered or issued for delivery in this
13 Commonwealth.
14 (c) Benefit plans.--In developing the ten standard basic
15 health insurance plans, the department must ensure that each
16 standardized plan covers basic or core benefits and has a
17 different set of benefits. All plans with the same letter shall
18 cover the same benefits. Plan A shall cover only the basic or
19 core benefits and Plan J shall cover the most benefits.
20 (d) Copayment and deductibles.--The department may establish
21 a copayment or deductible for each of the basic health insurance
22 plans.
23 Section 5. Offering and rate filing of basic health insurance
24 plans.
25 (a) Offering.--Insurers may offer, as an option, one or more
26 of the basic health insurance plans developed by the department
27 to a qualified individual and small employer.
28 (b) Filing.--Insurers must file their rates with the
29 department for approval by the commissioner for each basic
30 health insurance plan that they intend to deliver or issue for
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1 delivery to any qualified individual and small employer in this
2 Commonwealth.
3 (c) Additional coverage.--Insurers may offer benefits in
4 addition to those offered under the basic health insurance plans
5 and charge an additional premium accordingly.
6 Section 6. Disclosure statement.
7 (a) Written disclosure.--When an insurer issues a basic
8 health insurance plan policy, the insurer shall provide an
9 applicant or subscriber of the basic health insurance plan with
10 a written disclosure statement in a form and manner required by
11 rule or regulation promulgated by the commissioner that:
12 (1) Acknowledges that the basic health insurance plan
13 being purchased does not provide some or all State-mandated
14 health benefits.
15 (2) Lists those State-mandated health benefits not
16 included under the basic health insurance plan.
17 (3) Includes a section that allows for a signature by
18 the applicant or subscriber attesting to the fact that the
19 applicant or subscriber has read and understood the
20 disclosure statement.
21 (b) Return of disclosure.--
22 (1) Each applicant and subscriber for initial coverage
23 of a basic health insurance plan must sign the disclosure
24 statement provided by the insurer under subsection (a) and
25 return the statement to the insurer.
26 (2) Under a group policy or contract, the term
27 "applicant" means the employer and the term "subscriber"
28 means the employee. Under an individual policy or contract
29 "applicant" means the individual purchasing the policy.
30 (c) Record retention.--An insurer must:
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1 (1) Retain the signed disclosure statement in the
2 insurer's records.
3 (2) Provide the signed disclosure statement to the
4 department upon the request from the commissioner.
5 Section 7. Additional policies.
6 An insurer that offers one or more basic health insurance
7 plans to a qualified individual and small employer must also
8 offer at least one health insurance policy that has been filed
9 and approved with the department and includes coverage for all
10 State-mandated health benefits. A small employer that offers a
11 basic health insurance plan to its eligible employees must offer
12 at least one health insurance policy that includes coverage for
13 all State-mandated health benefits that has been filed and
14 approved by the department.
15 Section 8. Regulations.
16 The commissioner shall promulgate any rules and regulations
17 necessary to implement the provisions of this act.
18 Section 9. Effective date.
19 This act shall take effect in 60 days.
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