PRINTER'S NO. 85
No. 85 Session of 1991
INTRODUCED BY DEMPSEY, NOYE, LAUGHLIN, PESCI, JOHNSON, TRELLO,
HALUSKA, GODSHALL, NAILOR, HECKLER, CIVERA, HESS, HERMAN,
FOX, BUNT, FLICK AND E. Z. TAYLOR, JANUARY 29, 1991
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 29, 1991
AN ACT
1 Providing for Insurance Department jurisdiction over the
2 providers of health care benefits.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Authority and jurisdiction of Insurance Department.
6 Notwithstanding any other provision of law, and except as
7 provided in this act, any person or other entity which provides
8 benefits in this Commonwealth for medical, surgical,
9 chiropractic, physical therapy, speech pathology, audiology,
10 professional mental health, dental, hospital or optometric
11 expenses, whether the benefits are provided by direct payment,
12 reimbursement or otherwise, shall be presumed to be subject to
13 the jurisdiction of the Insurance Department, unless the person
14 or other entity shows that, while providing those services, it
15 is subject to the jurisdiction of another agency of this
16 Commonwealth, any subdivisions thereof, or the Federal
17 Government with respect to financial solvency.
1 Section 2. How to show jurisdiction.
2 A person or entity may show that it is subject to the
3 jurisdiction of another agency of this Commonwealth, or any
4 subdivision thereof, or of the Federal Government, by providing
5 to the Insurance Commissioner the appropriate certificate,
6 license or other document issued by the other governmental
7 agency which permits or qualifies it to provide those services.
8 Such certificate, license or other document may constitute
9 evidence that a person or entity is subject to the jurisdiction
10 of another agency of this Commonwealth, or any subdivision
11 thereof, or of the Federal Government, but such evidence is
12 subject to rebuttal. A Department of Labor letter concerning an
13 entity's purported status under The Employee Retirement Income
14 Security Act of 1974 (Public Law 93-406, 29 U.S.C. § 1001 et
15 seq.) is not a certificate, license or other document, within
16 the meaning of this section which permits or qualifies an entity
17 to provide services.
18 Section 3. Examination.
19 Any person or entity which is unable to show under section 2
20 that it is subject to the jurisdiction of another agency of this
21 Commonwealth or any subdivision thereof, or the Federal
22 Government, shall submit to an examination by the Insurance
23 Commissioner to determine the organization and solvency of the
24 person or the entity, and to determine whether or not such
25 person or entity complies with the applicable provisions of law.
26 The person or entity examined shall be responsible for the
27 Insurance Department's examination expenses to the same extent
28 as a licensed insurance company would be responsible, if the
29 person or entity is found to be subject to the Insurance
30 Department's jurisdiction.
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1 Section 4. Subject to State laws.
2 Any person or entity unable to show that it is subject to the
3 jurisdiction of another agency of this Commonwealth, or any
4 subdivision thereof, or of the Federal Government, shall be
5 subject to all appropriate provisions of law regarding the
6 conduct of its business.
7 Section 5. Disclosure.
8 (a) General rule.--Any person, entity, agent or
9 administrator which advertises, sells, transacts or administers
10 in this Commonwealth the benefits described in section 1, and
11 which is required to submit to an examination by the Insurance
12 Commissioner under section 3, shall, if said benefits are not
13 fully insured or otherwise fully covered by any insurer licensed
14 to do the business of insurance in this Commonwealth, nonprofit
15 hospital service plan or nonprofit health care plan, give notice
16 to every purchaser, prospective purchaser and covered person of
17 such lack of insurance or other coverage and lack of State
18 insurance insolvency guaranty funds protection.
19 (b) Duties of administrator.--Any administrator which
20 advertises or administers in this Commonwealth the benefits
21 described in section 1, and which is required to submit to an
22 examination by the Insurance Commissioner under section 3, shall
23 give notice to any person or agent, as described in subsection
24 (a), of the elements of the coverage, including, but not limited
25 to, the amount of "stop-loss" insurance in effect and lack of
26 State insurance insolvency guaranty funds protection.
27 (c) Required notice.--The notice described in subsections
28 (a) and (b) shall be in ten-point type on any solicitation,
29 application, description of benefits, renewal form or any other
30 form provided to any person covered by a person or entity
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1 described in section 1.
2 Section 6. Penalty.
3 Upon satisfactory evidence of the violation of any of the
4 provisions of this act, the Insurance Commissioner may, in his
5 discretion, pursue any one or more of the following courses of
6 action, regardless of whether such person, entity, agent,
7 solicitor, broker or company is licensed or not licensed by the
8 Insurance Commissioner:
9 (1) Suspend or revoke or refuse to renew the license of
10 such offending party or parties.
11 (2) Impose a civil penalty of not more than $1,000 for
12 each and every act in violation of any of said sections by
13 said party or parties.
14 Section 7. Effective date.
15 This act shall take effect in 60 days.
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