1Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2act relating to insurance; amending, revising, and
3consolidating the law providing for the incorporation of
4insurance companies, and the regulation, supervision, and
5protection of home and foreign insurance companies, Lloyds
6associations, reciprocal and inter-insurance exchanges, and
7fire insurance rating bureaus, and the regulation and
8supervision of insurance carried by such companies,
9associations, and exchanges, including insurance carried by
10the State Workmen's Insurance Fund; providing penalties; and
11repealing existing laws," further providing for forms for
12health insurance claims.

13The General Assembly of the Commonwealth of Pennsylvania
14hereby enacts as follows:

15Section 1. Section 1202 of the act of May 17, 1921 (P.L.682, 
16No.284), known as The Insurance Company Law of 1921, added 
17December 15, 1992 (P.L.1129, No.148), is amended to read:

18Section 1202. Forms for Health Insurance Claims.--(a) Each
19health insurance claim form processed or otherwise used by an
20insurer, including those used by the Department of Public
21Welfare for public health care coverage, shall be the uniform
22claim form developed by the department. The claim form shall be

1identical in form and content except as provided in [subsection
2(c)] subsections (c) and (c.1). The department shall, in
3consultation with the Department of Public Welfare, insurers and
4health care providers or their representatives, first consider
5the feasibility of utilizing the UB-82/HCFA-1450 and HCFA-1500
6forms, or their successors, as a uniform claim form. If these
7forms are deemed to be unsatisfactory, the department shall, in
8consultation with the Department of Public Welfare, insurers and
9health care providers or their representatives, develop a
10uniform claim form for use by all insurers, the Department of
11Public Welfare's public health care coverage program and health
12care providers. The uniform claim form shall contain blank
13spaces at appropriate places in the document for approved
14additional information requests under subsection (c).

15(b) The feasibility study and subsequent development of the
16uniform claim form shall be complete within one hundred eighty
17(180) days of the effective date of this article. All insurers,
18the Department of Public Welfare's public health care coverage
19program and health care providers shall be required to use the
20uniform claim form within one hundred twenty (120) days after
21the uniform claim form is developed. The department may consider
22a request from the Department of Public Welfare for an extension
23in meeting the implementation schedule of this section.

24(c) (1) Subject to the procedure contained in clause (2),
25an insurer may request that a claimant provide departmentally
26approved additional information which is not requested on the
27uniform claim form.

28(2) An insurer may request departmental approval of 
29additional information requests to be printed in the blank 
30spaces on the uniform claim form, and on subsequent pages if 

1necessary, by submitting a written request to the department. 
2Such a request shall be deemed approved by the department if not 
3disapproved within sixty (60) days after receipt of the request. 
4A disapproval shall be subject to the procedures under 2 Pa.C.S. 
5(relating to administrative law and procedure).

6(c.1) If, in a dental claim form, an insured specifically
7authorizes payment of benefits directly to an entity or person
8who provided dental services in accordance with the provisions
9of the policy, the insurer shall make the payment to the
10specified provider of the dental services. The insurance
11contract may not prohibit, and claim forms must provide an
12option for, the payment of benefits directly to the specified
13provider of the dental services. The insurer may require written
14attestation of the assignment of the payment. Payment to the
15specified provider of the dental services from the insurer may
16not be more than the amount that the insurer would otherwise
17have paid without the assignment of payment.

18(d) In the case of vision and dental claim forms and in the
19case of supplemental major medical claim forms, utilization of
20the uniform claim form shall be at the discretion of the
21individual insurer.

22Section 2. This act shall take effect in 60 days.