PRINTER'S NO. 348
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
330
Session of
2015
INTRODUCED BY DeLUCA, FREEMAN, FRANKEL, BROWNLEE, CALTAGIRONE,
SCHLOSSBERG, D. COSTA, COHEN, READSHAW AND SCHWEYER,
FEBRUARY 4, 2015
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 4, 2015
AN ACT
Providing for the American Health Benefit Exchange Act;
establishing the Pennsylvania Health Insurance Exchange;
imposing duties on the Insurance Department; and providing
for powers and duties of the exchange, for health benefit
plan certification, for funding and publication of costs and
for regulations.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the American
Health Benefit Exchange Act.
Section 2. Purpose and intent.
The purpose of this act is to provide for the establishment
of an American Health Benefit Exchange to facilitate the
purchase and sale of qualified health plans in the individual
market in this Commonwealth and to provide for the establishment
of a Small Business Health Options Program to assist qualified
small employers in this Commonwealth in facilitating the
enrollment of their employees in qualified health plans offered
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in the small group market.
Section 3. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Department." The Insurance Department of the Commonwealth.
"Educated health care consumer." An individual who is
knowledgeable about the health care system and has background or
experience in making informed decisions regarding health,
medical and scientific matters.
"Exchange." The Pennsylvania Health Insurance Exchange
established under section 4.
"Federal act." The Patient Protection and Affordable Care
Act (Public Law 111-148, 124 Stat. 119) and regulations or
guidance issued thereunder.
"Health benefit plan." A policy, contract, certificate or
agreement offered or issued by a health carrier to provide,
deliver, arrange for, pay for or reimburse the costs of health
care services. The term does not apply to the following types of
policies:
(1) accident only;
(2) limited benefit;
(3) credit;
(4) dental;
(5) vision;
(6) specified disease;
(7) medicare supplement;
(8) Civilian Health and Medical Program of the Uniformed
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Services supplement.
(9) long-term care or disability income;
(10) worker's compensation; or
(11) automobile medical payment.
"Health carrier" or "carrier." An entity that contracts or
offers to contract to provide, deliver, arrange for, pay for or
reimburse the costs of health care services and is organized
under:
(1) the act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921;
(2) the act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act;
(3) the act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act; or
(4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"Qualified dental plan." A limited scope dental plan that
has been certified in accordance with section 7(d).
"Qualified employer." A small employer that elects to make
its full-time employees eligible for one or more qualified
health plans offered through the SHOP exchange and, at the
option of the employer, some or all of its part-time employees
provided the employer:
(1) has its principal place of business in this
Commonwealth and elects to provide coverage through the
exchange to its eligible employees, wherever employed; or
(2) elects to provide coverage through the SHOP exchange
to its eligible employees who are principally employed in
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this Commonwealth.
"Qualified health plan." A health benefit plan that has
certification that the plan meets the criteria for certification
described in section 1311(c) of the Patient Protection and
Affordable Care Act (Public Law 111-148, 124 Stat. 119) and
section 7 in effect.
"Qualified individual." An individual, including a minor,
who:
(1) Is seeking to enroll in a qualified health plan
offered to individuals through the exchange.
(2) Resides in this Commonwealth.
(3) At the time of enrollment, is not incarcerated,
other than incarceration pending the disposition of charges.
(4) Is reasonably expected to be, for the entire period
for which enrollment is sought, a citizen or national of the
United States or an alien lawfully present in the United
States.
"Secretary." The Secretary of the United States Department
of Health and Human Services.
"SHOP exchange." The Small Business Health Options Program
that the exchange is required to establish under section 6(a)
(12).
"Small employer."
(1) An employer that employed an average of not more
than 50 employees during the preceding calendar year.
(2) The following shall apply:
(i) All persons treated as a single employer under
subsection (b), (c), (m) or (o) of section 414 of the
Internal Revenue Code of 1986 (Public Law 99-514, 26
U.S.C. ยง 414) shall be treated as a single employer.
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(ii) An employer and a predecessor employer shall be
treated as a single employer.
(iii) All employees shall be counted, including
part-time employees and employees who are not eligible
for coverage through the employer.
(iv) If an employer was not in existence throughout
the preceding calendar year, the determination of whether
that employer is a small employer shall be based on the
average number of employees that is reasonably expected
that employer will employ on business days in the current
calendar year.
(v) An employer that makes enrollment in qualified
health plans available to its employees through the SHOP
exchange, and would cease to be a small employer by
reason of an increase in the number of its employees,
shall continue to be treated as a small employer for
purposes of this act as long as it continuously makes
enrollment through the SHOP program available to its
employees.
Section 4. Pennsylvania Health Insurance Exchange.
(a) Establishment.--The Pennsylvania Health Insurance
Exchange is established.
(b) Membership.--The exchange shall consist of the following
members:
(1) Three members of the general public appointed by the
Governor.
(2) Two members of the Senate appointed by the Majority
Leader of the Senate.
(3) Two members of the Senate appointed by the Minority
Leader of the Senate.
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(4) Two members of the House of Representatives
appointed by the Majority Leader of the House of
Representatives.
(5) Two members of the House of Representatives
appointed by the Minority Leader of the House of
Representatives.
(6) The Secretary of the Budget.
(7) The Secretary of Health.
(8) The Secretary of Human Services.
(9) The Insurance Commissioner.
(c) Chairperson.--The Governor shall appoint a chairperson
of the exchange from one of the three gubernatorial appointees.
A member appointed under subsection (b)(2), (3), (4) or (5) may
appoint a designee to attend meetings on the member's behalf.
(d) Qualifications.--The members of the exchange shall be 21
years of age or older, citizens of the United States and
residents of this Commonwealth.
(e) Initial appointments.--Initial appointments to the
exchange shall be made within 30 days of the effective date of
this section and shall be made as follows:
(1) Gubernatorial appointees initially appointed under
subsection (b)(1) shall serve initial terms of two, three and
four years, respectively, as designated by the Governor at
the time of appointment and until their successors are
appointed and qualified.
(2) Legislative appointees initially appointed under
subsection (b)(2), (3), (4) or (5) shall serve until the
third Tuesday in January 2018 and until their successors are
appointed and qualified.
(f) Terms of office.--Upon the expiration of a term of a
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member appointed under subsection (b), the following shall
apply:
(1) The term of office of a gubernatorial appointee
shall be three years and until a successor is appointed and
qualified.
(2) The term of office of a legislative appointee shall
be two years and until a successor is appointed and
qualified.
(3) A legislative appointee shall serve no more than
three full consecutive terms.
(4) A gubernatorial appointee shall serve no more than
two full consecutive terms.
(g) Vacancies.--Appointments to fill vacancies shall be made
within 60 days of the creation of the vacancy. Members who are
appointed to fill vacancies may continue to serve on the
exchange as follows:
(1) A member appointed to fill a vacancy under
subsection (f)(1) may serve two full terms following the
expiration of the term related to the vacancy.
(2) A member appointed to fill a vacancy under
subsection (f)(2) may serve three full terms following the
expiration of the term related to the vacancy.
(h) Reimbursement for expenses.--Members of the exchange may
be reimbursed for reasonable expenses for their attendance at
exchange meetings as well as any committee meetings.
(i) Meetings.--The exchange shall hold meetings as often as
necessary but no less than on a quarterly basis. The first
meeting of the exchange shall be held within 60 days of the
effective date of this section.
(j) Quorum.--For the purpose of conducting exchange
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business, a quorum shall be at least one more than half the
number of exchange members.
(k) Qualified majority vote.--A majority of members of the
exchange present at a meeting constitute a qualified majority
vote.
Section 5. General requirements.
(a) Deadline.--The exchange shall make qualified health
plans available to qualified individuals and qualified employers
beginning on or before January 1, 2017.
(b) Prohibition.--The exchange shall not make available any
health benefit plan that is not a qualified health plan.
(c) Limited scope dental benefits.--The exchange shall allow
a health carrier to offer a plan that provides limited scope
dental benefits meeting the requirements of section 9832(c)(2)
(A) of the Internal Revenue Code of 1986 (Public Law 99-514, 26
U.S.C. ยง 9832(c)(2)(A)) through the exchange, either separately
or in conjunction with a qualified health plan, if the plan
provides pediatric dental benefits meeting the requirements of
section 1302(b)(1)(J) of the Federal act.
(d) Additional prohibition.--Neither the exchange nor a
carrier offering health benefit plans through the exchange may
charge an individual a fee or penalty for termination of
coverage if the individual enrolls in another type of minimum
essential coverage because the individual has become newly
eligible for that coverage or because the individual's employer-
sponsored coverage has become affordable under the standards of
section 36B(c)(2)(C) of the Internal Revenue Code of 1986.
Section 6. Powers and duties of exchange.
(a) Duties.--The exchange shall:
(1) Facilitate the purchase and sale of qualified health
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plans.
(2) Provide for the establishment of a SHOP exchange,
separate from the activities of the exchange related to the
individual market and that is designed to assist qualified
small employers in this Commonwealth in facilitating the
enrollment of their employees in qualified health plans.
(3) Meet the requirements of this act and any
regulations implemented under this act.
(4) Implement procedures for the certification,
recertification and decertification, consistent with
guidelines developed by the secretary under section 1311(c)
of the Federal act and section 7, of health benefit plans as
qualified health plans.
(5) Provide for the operation of a toll-free telephone
hotline to respond to requests for assistance.
(6) Provide for enrollment periods, as determined by the
secretary under section 1311(c)(6) of the Federal act.
(7) Maintain an Internet website through which enrollees
and prospective enrollees of qualified health plans may
obtain standardized comparative information on the plans.
(8) Assign a rating to each qualified health plan
offered through the exchange in accordance with the criteria
developed by the secretary under section 1311(c)(3) of the
Federal act and determine each qualified health plan's level
of coverage in accordance with regulations issued by the
secretary under section 1302(d)(2)(A) of the Federal act.
(9) Use a standardized format for presenting health
benefit options in the exchange, including the use of the
uniform outline of coverage established under section 2715 of
the Public Health Service Act (58 Stat. 682, 42 U.S.C.
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ยง 300gg-15).
(10) In accordance with section 1413 of the Federal act,
inform individuals of eligibility requirements for the
Medicaid program under Title XIX of the Social Security Act
(49 Stat. 620, 42 U.S.C. ยง 1396 et seq.), the Children's
Health Insurance Program under Title XXI of the Social
Security Act or an applicable State or local public program
and, if, through screening of the application by the
exchange, the exchange determines an individual is eligible
for a program, enroll the individual in the program.
(11) Establish and make available by electronic means a
calculator to determine the actual cost of coverage after
application of any premium tax credit under section 36B of
the Internal Revenue Code of 1986 (Public Law 99-514, 26
U.S.C. ยง 36B) and any cost-sharing reduction under section
1402 of the Federal act.
(12) Establish a SHOP exchange through which qualified
employers may access coverage for their employees, which
shall enable a qualified employer to specify a level of
coverage so its employees may enroll in a qualified health
plan offered through the SHOP exchange at the specified level
of coverage.
(13) Subject to section 1411 of the Federal act, grant a
certification attesting that, for purposes of the individual
responsibility penalty under section 5000A of the Internal
Revenue Code of 1986, an individual is exempt from the
individual responsibility requirement or from the penalty
imposed by that section because:
(i) there is no affordable qualified health plan
available through the exchange or the individual's
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employer covering the individual; or
(ii) the individual meets the requirements for
another exemption from the individual responsibility
requirement or penalty.
(14) Transfer the following to the United States
Secretary of the Treasury:
(i) A list of the individuals who are issued a
certification under paragraph (13), including the name
and taxpayer identification number of each individual.
(ii) The name and taxpayer identification number of
each individual who was an employee of an employer but
who was determined to be eligible for the premium tax
credit under section 36B of the Internal Revenue Code of
1986 because:
(A) the employer did not provide minimum
essential health benefits coverage; or
(B) the employer provided the minimum essential
health benefits coverage, but it was determined under
section 36B(c)(2)(C) of the Internal Revenue Code of
1986 to either be unaffordable to the employee or not
provide the required minimum actuarial value.
(iii) The name and taxpayer identification number
of:
(A) Each individual who notifies the exchange
under section 1411(b)(4) of the Federal act that the
individual has changed employers.
(B) Each individual who ceases coverage under a
qualified health plan during a plan year and the
effective date of that cessation.
(15) Provide to each employer the name of each employee
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of the employer described in paragraph (14)(ii) who ceases
coverage under a qualified health plan during a plan year and
the effective date of the cessation.
(16) Perform duties required of the exchange by the
secretary or the United States Secretary of the Treasury
related to determining eligibility for premium tax credits,
reduced cost-sharing or individual responsibility requirement
exemptions.
(17) Select entities qualified to serve as navigators in
accordance with section 1311(i) of the Federal act and award
grants to enable navigators to:
(i) Conduct public education activities to raise
awareness of the availability of qualified health plans.
(ii) Distribute fair and impartial information
concerning enrollment in qualified health plans and the
availability of premium tax credits under section 36B of
the Internal Revenue Code of 1986 and cost-sharing
reductions under section 1402 of the Federal act.
(iii) Facilitate enrollment in qualified health
plans.
(iv) Provide referrals to an applicable office of
health insurance consumer assistance or health insurance
ombudsman established under section 2793 of the Public
Health Service Act, or other appropriate State agency,
for an enrollee with a grievance, complaint or question
regarding the enrollee's health benefit plan, coverage or
a determination under the plan or coverage.
(v) Provide information in a manner that is
culturally and linguistically appropriate to the needs of
the population being served by the exchange.
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(18) Review the rate of premium growth within the
exchange and outside the exchange, and consider the
information in developing recommendations on whether to
continue limiting qualified employer status to small
employers.
(19) Consult with stakeholders relevant to carrying out
the activities required under this act, including:
(i) Educated health care consumers who are enrollees
in qualified health plans.
(ii) Individuals and entities with experience in
facilitating enrollment in qualified health plans.
(iii) Representatives of small businesses and self-
employed individuals.
(iv) The medical assistance program within the
Department of Human Services.
(v) Advocates for enrolling hard to reach
populations.
(20) Meet the following financial integrity
requirements:
(i) Keep an accurate accounting of activities,
receipts and expenditures and annually submit to the
secretary, the Governor, the commissioner and the General
Assembly a report concerning the accountings.
(ii) Fully cooperate with an investigation conducted
by the secretary under the secretary's authority under
the Federal act and allow the secretary, in coordination
with the Inspector General of the United States
Department of Health and Human Services, to:
(A) Investigate the affairs of the exchange.
(B) Examine the properties and records of the
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exchange.
(C) Require periodic reports in relation to the
activities undertaken by the exchange.
(iii) In carrying out its activities under this act,
not use funds intended for the administrative and
operational expenses of the exchange for staff retreats,
promotional giveaways, excessive executive compensation
or promotion of Federal or State legislative and
regulatory modifications.
(b) Contracting.--The exchange may contract with an eligible
entity for any of its functions described in this act. An
eligible entity includes, but is not limited to, the Department
of Human Services or an entity that has experience in individual
and small group health insurance, but a health carrier or an
affiliate of a health carrier is not an eligible entity.
(c) Information-sharing agreements.--The exchange may enter
into information-sharing agreements with Federal and State
agencies and other State exchanges to carry out its
responsibilities under this act, provided the agreements include
adequate protections with respect to the confidentiality of the
information to be shared and comply with Federal and State laws
and regulations.
Section 7. Health benefit plan certification.
(a) Permissible certification.--The department may certify a
health benefit plan as a qualified health plan if:
(1) The plan provides the essential health benefits
package described in section 1302(a) of the Federal act,
except that the plan is not required to provide essential
benefits that duplicate the minimum benefits of qualified
dental plans, as provided in subsection (d), if:
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(i) The exchange has determined that an adequate
choice of qualified dental plans is available to
supplement the plan's coverage.
(ii) The carrier makes prominent disclosure at the
time it offers the plan, in a form approved by the
exchange, that the plan does not provide the full range
of essential pediatric benefits and that qualified dental
plans providing those benefits and other dental benefits
not covered by the plan are offered through the exchange.
(2) The premium rates and contract language have been
approved by the commissioner.
(3) The plan provides at least a bronze level of
coverage, unless the plan is certified as a qualified
catastrophic plan, meets the requirements of the Federal act
for catastrophic plans and will only be offered to
individuals eligible for catastrophic coverage.
(4) The plan's cost-sharing requirements do not exceed
the limits established under section 1302(c)(1) of the
Federal act, and, if the plan is offered through the SHOP
exchange, the plan's deductible does not exceed the limits
established under section 1302(c)(2) of the Federal act.
(5) The health carrier offering the plan:
(i) Is licensed and in good standing to offer health
insurance coverage in this Commonwealth.
(ii) Offers at least one qualified health plan in
the silver level and at least one plan in the gold level
through each component of the exchange in which the
carrier participates, where "component" refers to the
SHOP exchange and the exchange for individual coverage.
(iii) Charges the same premium rate for each
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qualified health plan without regard to whether the plan
is offered through the exchange and without regard to
whether the plan is offered directly from the carrier or
through an insurance producer.
(iv) Does not charge cancellation fees or penalties
in violation of section 5(d).
(v) Complies with the regulations developed by the
secretary under section 1311(d) of the Federal act and
other requirements as the exchange may establish.
(6) The plan meets the requirements of certification as
promulgated by regulation by the secretary under section
1311(c)(1) of the Federal act and by the exchange under
section 9.
(7) The exchange determines that making the plan
available through the exchange is in the interest of
qualified individuals and qualified employers in this
Commonwealth.
(b) Prohibitions.--The department shall not exclude a health
benefit plan:
(1) on the basis that the plan is a fee-for-service
plan;
(2) through the imposition of premium price controls by
the department; or
(3) on the basis that the health benefit plan provides
treatments necessary to prevent patients' deaths in
circumstances the exchange determines are inappropriate or
too costly.
(c) Requirements.--The exchange shall require each health
carrier seeking certification of a plan as a qualified health
plan to:
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(1) Subject to the act of December 18, 1996 (P.L.1066,
No.159), known as the Accident and Health Filing Reform Act,
submit a justification for a premium increase before
implementation of the increase. The carrier shall prominently
post the information on its publicly available Internet
website. The exchange shall take the information, along with
the information and the recommendations provided to the
exchange by the commissioner under section 2794(b) of the
Public Health Service Act (58 Stat. 682, 42 U.S.C. ยง 300gg-
94), into consideration when determining whether to allow the
carrier to make plans available through the exchange.
(2) (i) Make available to the public, in the format
described in subparagraph (ii), and submit to the
exchange, the secretary and the commissioner, accurate
and timely disclosure of the following:
(A) Claims payment policies and practices.
(B) Periodic financial disclosures.
(C) Data on enrollment.
(D) Data on disenrollment.
(E) Data on the number of claims that are
denied.
(F) Data on rating practices.
(G) Information on cost sharing and payments
with respect to any out-of-network coverage.
(H) Information on enrollee and participant
rights under Title I of the Federal act.
(I) Other information as determined appropriate
by the secretary.
(ii) The information required in subparagraph (i)
shall be provided in plain language, as that term is
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defined in section 1311(e)(3)(B) of the Federal act.
(3) Permit individuals to learn, in a timely manner upon
the request of the individual, the amount of cost sharing,
including deductibles, copayments and coinsurance, under the
individual's plan or coverage that the individual would be
responsible for paying with respect to the furnishing of a
specific item or service by a participating provider. At a
minimum, the information shall be made available to the
individual through an Internet website and through other
means for individuals without access to the Internet.
(d) Applicability.--
(1) The provisions of this act that are applicable to
qualified health plans shall also apply to the extent
relevant to qualified dental plans except as modified in
accordance with the provisions of paragraphs (2), (3) and (4)
or by regulations adopted by the exchange.
(2) The health carrier shall be licensed to offer dental
coverage but need not be licensed to offer other health
benefits.
(3) The plan shall be limited to dental and oral health
benefits, without substantially duplicating the benefits
typically offered by health benefit plans without dental
coverage, and shall include, at a minimum, the essential
pediatric dental benefits prescribed by the secretary under
section 1302(b)(1)(J) of the Federal act and other minimum
dental benefits as the exchange or the secretary may specify
by regulation.
(4) A health carrier and a dental carrier may jointly
offer a comprehensive plan through the exchange in which the
dental benefits are provided by the dental carrier and the
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other benefits are provided by the health carrier.
Section 8. Funding and publication of costs.
(a) Funding.--The exchange may charge assessments or user
fees to health carriers or otherwise may generate funding
necessary to support its operations provided under this act.
(b) Publication of costs.--The exchange shall publish the
average costs of licensing, regulatory fees and other payments
required by the exchange and the administrative costs of the
exchange on a publicly available Internet website to educate
consumers on the costs. The information shall include
information on money lost to waste, fraud and abuse.
Section 9. Regulations.
The exchange and the department may individually or jointly
promulgate regulations to implement the provisions of this act.
Regulations promulgated under this section shall not conflict
with or prevent the application of regulations promulgated by
the secretary under Subtitle D of Title I of the Federal act.
Section 10. Relation to other laws.
This act and an action taken by the exchange under this act
may not be construed to preempt or supersede the authority of
the department and the commissioner to regulate the business if
insured within this Commonwealth. Except as expressly provided
to the contrary in this act, health carriers offering qualified
health plans in this Commonwealth shall comply with the
applicable insurance laws and regulations of this Commonwealth
and orders issued by the department or commissioner.
Section 11. Effective date.
This act shall take effect in 180 days.
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