PRINTER'S NO. 97
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
132
Session of
2017
INTRODUCED BY BAKER, MILLARD, GREINER, RAPP, MURT, BARRAR,
KAUFFMAN, MENTZER, PHILLIPS-HILL, BOBACK, READSHAW, GROVE,
WARD, MARSICO, WATSON AND GABLER, JANUARY 23, 2017
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 23, 2017
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in preliminary provisions, providing for foreign
health insurance.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 3
FOREIGN HEALTH INSURANCE
Sec.
301. Scope of chapter.
302. Definitions.
303. Out-of-State carriers' provision of coverage.
304. Certificate of authority.
305. Required disclosures.
306. Powers and duties of commissioner.
§ 301. Scope of chapter.
This chapter relates to foreign health insurance.
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§ 302. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Covered person." An individual who is entitled to health
care services provided, arranged for, paid for or reimbursed
under a health benefits plan.
"Domestic health insurer." An insurer licensed to sell,
offer or provide health benefits plans in this Commonwealth.
"Foreign health insurer." An insurer licensed to sell, offer
or provide health benefits plans in any other state.
"Hazardous financial condition." A condition in which a
foreign health insurer is unlikely to be able to meet
obligations to policyholders with respect to known claims or to
any other obligations in the normal course of business, based on
its present or reasonably anticipated financial status.
"Health benefits plan." An arrangement for the delivery of
health care, on an individual or group basis, in which a health
carrier undertakes to provide, arrange for, pay for or reimburse
any of the costs of health care services for a covered person
that is offered in accordance with the laws of any state. The
term does not include any of the following:
(1) Short-term travel, accident only, limited or
specified disease or individual conversion policies or
contracts.
(2) Policies or contracts designed for issuance to
persons eligible for coverage under Title XVIII of the Social
Security Act (49 Stat. 620, 42 U.S.C. § 1395 et seq.).
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(3) Any other coverage, similar to that listed under
paragraph (1) or (2), under Federal or State governmental
plans.
"Provider" or "health care provider." Any hospital,
physician, or other person authorized by statute, licensed or
certified to furnish health care services.
"Resident." An individual whose primary residence is in this
Commonwealth and who is present in this Commonwealth for at
least six months of the calendar year.
§ 303. Out-of-State carriers' provision of coverage.
Notwithstanding any other law or regulation, a foreign health
insurer may sell, offer and provide a health benefits plan to
residents in this Commonwealth if that insurer does all of the
following:
(1) Offers the health benefit plan in its domiciliary
state and is in compliance with all applicable laws,
regulations and requirements of its domiciliary state.
(2) Obtains a certificate of authority to do business as
a foreign health insurer in this Commonwealth.
(3) Complies with all laws and regulations of this
Commonwealth enacted for the benefit of health insurance
consumers.
(4) Is not required to offer the health benefits
mandated by the laws or regulations of this Commonwealth, or
comply with any law regarding rate regulation.
§ 304. Certificate of authority.
(a) Application.--A foreign health insurer may apply for a
certificate that authorizes the foreign health insurer to do
business as a foreign health insurer in this Commonwealth using
a form prescribed by the commissioner. Upon application, the
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commissioner shall issue a certificate to the foreign health
insurer unless the commissioner determines that the foreign
health insurer meets any of the following:
(1) Will not provide a health benefits plan in
compliance with the provisions of this chapter.
(2) Is in a hazardous financial condition, as determined
by an examination by the commissioner conducted in accordance
with the Financial Analysis Handbook of the National
Association of Insurance Commissioners.
(3) Has not adopted procedures to ensure compliance with
all applicable laws governing the confidentiality of its
records with respect to providers and covered persons.
(b) Validity.--A certificate of authority issued under this
section shall be valid for three years from the date of issuance
by the commissioner. The commissioner shall, by regulation,
establish all of the following:
(1) Procedures for a foreign health insurer to renew a
certificate of authority under this chapter.
(2) Certificate of authority application and renewal
fees, the amount of which shall be no greater than is
reasonably necessary to enable the commissioner to carry out
the provisions of this chapter.
§ 305. Required disclosures.
Each health benefits plan and each application for a health
benefits plan provided by a foreign health insurer to a resident
shall disclose all of the following in plain language:
(1) The differences between the benefits of the health
benefits plan issued by the foreign health insurer and a
health benefits plan issued under the laws of this
Commonwealth.
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(2) The differences that relate to mandated health
benefits, underwriting standards, premium rating, preexisting
conditions, renewability, portability and cancellation.
(3) That the health benefits plan is primarily governed
by the laws of the foreign health insurer's domicile and
therefore all of the rating laws applicable to individual or
group accident and health insurance filed in this
Commonwealth do not apply to the health benefits plan, which
may result in increases to the insurance premium at the time
of renewal that would not be permissible with a health
benefits plan governed by the laws of this Commonwealth.
(4) That any purchase of health insurance should be
considered carefully since future medical conditions may make
it impossible to qualify for another health benefits plan.
(5) That although the health benefits plan may provide
more affordable health coverage, the following apply:
(i) The health benefits plan may also provide fewer
health benefits than those normally included as State-
mandated health insurance policies issued by domestic
health insurers.
(ii) The insured's insurance agent should be
consulted to determine which State-mandated health
benefits are excluded under the policy.
§ 306. Powers and duties of commissioner.
(a) Powers.--The commissioner may do all of the following:
(1) After notice and opportunity to be heard, deny,
revoke or suspend a certificate of authority issued to a
foreign health insurer for any violation of this chapter. The
commissioner shall provide for an appropriate and timely
right of appeal for a foreign health insurer whose
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certificate of authority is denied, revoked or suspended.
(2) Conduct market conduct and solvency examinations of
an existing or prospective foreign health insurer. The market
conduct and solvency examinations shall be conducted in the
same manner and under the same terms and conditions as an
examination of an insurer located in this State.
(b) Duties.--
(1) The commissioner shall establish procedures for the
review of claims and grievances filed by a health care
provider or a covered individual, marketing materials
proposed by a foreign health insurer to market a health
benefit plan to residents or employers in this State and the
application and health benefit plan of a prospective foreign
health insurer.
(2) The commissioner shall adopt rules to administer
this chapter. The rules shall not do any of the following:
(i) Require the foreign health insurer to modify
coverage or benefit requirements or restrict underwriting
requirements or premium ratings in a manner that
conflicts with the laws or regulations of a foreign
health insurer's domiciliary state.
(ii) Provide for an expansion of the commissioner's
authority over foreign health insurers in a way that
conflicts with this chapter.
Section 2. This act shall take effect in 60 days.
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