PRINTER'S NO. 1365
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
939
Session of
2019
INTRODUCED BY IOVINO, HUGHES, FARNESE, LEACH, FONTANA, COLLETT,
SANTARSIERO, TARTAGLIONE, SCHWANK, COSTA AND BREWSTER,
NOVEMBER 12, 2019
REFERRED TO BANKING AND INSURANCE, NOVEMBER 12, 2019
AN ACT
Providing for health care insurance coverage protections, for
duties of the Insurance Department and the Insurance
Commissioner, for regulations, for enforcement and for
penalties.
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 Health
Insurance Protection Against Limitations Act.
Section 2. 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.
"Enrollee." A policyholder, subscriber, covered person or
other individual who is entitled to receive health care services
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under a health insurance policy.
"Group health insurance policy." A policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to
individuals who obtain health insurance coverage through a
group.
"Health insurance policy." A policy, subscriber contract,
certificate or plan issued by an insurer that provides medical
or health care coverage. The term does not include any of the
following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A fixed indemnity policy.
(7) A dental only policy.
(8) A vision only policy.
(9) A workers' compensation policy.
(10) An automobile medical payment policy.
(11) A policy under which benefits are provided by the
Federal Government to active or former military personnel and
their dependents.
(12) Any other similar policies providing for limited
benefits.
"Individual health insurance policy." A policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to an
individual other than in connection with a group.
"In-network provider." A provider who contracts with an
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insurer to provide health care services to an enrollee under a
health insurance policy.
"Insurer." An entity that offers, issues or renews an
individual or group health insurance policy that provides
medical or health care coverage by a health care facility or
licensed health care provider and that is governed under any of
the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV of 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) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Out-of-network provider." A provider who does not contract
with an insurer to provide health care services to an enrollee
under a health insurance policy.
Section 3. Limitation on annual and lifetime limits.
(a) Generally.--Except as otherwise provided in this
section, an insurer offering, issuing or renewing an individual
or group health insurance policy may not establish, on either an
annual or lifetime basis, a limit on the dollar value of any
core benefit for an enrollee, whether provided by an in-network
or out-of-network provider.
(b) Core benefit.--For purposes of this section, a core
benefit shall include:
(1) A benefit for which no annual or lifetime per
enrollee limit was permitted to be included in an individual
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or small group policy first offered or issued in this
Commonwealth in 2018.
(2) A benefit hereafter specified by the department by
regulation.
(c) Benefits not subject to limitation.--The Commissioner
may promulgate regulations to exempt a benefit from the
definition of core benefit under subsection (b) for the purposes
of the limitation prohibitions under this section.
(d) No coverage requirement.--This section shall not be
construed to require coverage of any specific benefit.
Section 4. Regulations.
(a) Authority to promulgate.--The department may promulgate
regulations as may be necessary and appropriate to carry out the
provisions of this act.
(b) Temporary regulations.--
(1) Notwithstanding any other provision of law, in order
to facilitate the prompt implementation of this act, the
department may issue temporary regulations which shall expire
no later than two years following publication of the
temporary regulations in the Pennsylvania Bulletin. The
temporary regulations shall be exempt from the following:
(i) Sections 201, 202, 203, 204 and 205 of the act
of July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(ii) Section 204(b) of the act of October 15, 1980
(P.L.950, No.164), known as the Commonwealth Attorneys
Act.
(iii) The act of June 25, 1982 (P.L.633, No.181),
known as the Regulatory Review Act.
(iv) Section 612 of the act of April 9, 1929
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(P.L.177, No.175), known as The Administrative Code of
1929.
(2) The authority of the department to issue temporary
regulations under this subsection shall expire two years from
the effective date of this section. Regulations adopted after
the two-year period shall be promulgated as provided by
statute.
Section 5. Enforcement.
(a) General rule.--Upon satisfactory evidence of the
violation of any section of this act by an insurer or any other
person, one or more of the following penalties may be imposed at
the commissioner's discretion:
(1) Suspension or revocation of the license of the
offending insurer or other person.
(2) Refusal, for a period not to exceed one year, to
issue a new license to the offending insurer or other person.
(3) A fine of not more than $5,000 for each violation of
this act.
(4) A fine of not more than $10,000 for each willful
violation of this act.
(b) Limitation.--
(1) Fines imposed against an individual insurer under
this act may not exceed $500,000 in the aggregate during a
single calendar year.
(2) Fines imposed against any other person under this
act may not exceed $100,000 in the aggregate during a single
calendar year.
(c) Additional remedies.--The enforcement remedies imposed
under this section are in addition to any other remedies or
penalties that may be imposed under any other applicable law of
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this Commonwealth, including:
(1) The act of July 22, 1974 (P.L.589, No.205), known as
the Unfair Insurance Practices Act. Violations of this act
shall be deemed to be an unfair method of competition and an
unfair or deceptive act or practice under the Unfair
Insurance Practices Act.
(2) The act of December 18, 1996 (P.L.1066, No.159),
known as the Accident and Health Filing Reform Act.
(3) The act of June 25, 1997 (P.L.295, No.29), known as
the Pennsylvania Health Care Insurance Portability Act.
(d) Administrative procedure.--The administrative provisions
of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies).
A party against whom penalties are assessed in an administrative
action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
Ch. 7 Subch. A (relating to judicial review of Commonwealth
Agency action).
Section 6. Applicability.
This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Insurance
Department, this act shall apply to any policy for which a
form or rate is first filed on or after the effective date of
this act.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Insurance
Department, this act shall apply to any policy issued or
renewed on or after 180 days after the effective date of this
act.
Section 7. Repeals.
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All acts and parts of acts are repealed insofar as they are
inconsistent with this act.
Section 8. Effective date.
This act shall take effect immediately.
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