Regular Session 2021-2022 House Bill 0172 P.N. 0139

PRINTER'S NO. 139

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

172

Session of

2021

INTRODUCED BY DeLUCA, KINSEY, HILL-EVANS, PASHINSKI, FREEMAN,

T. DAVIS, A. DAVIS, WEBSTER AND CIRESI, JANUARY 14, 2021

REFERRED TO COMMITTEE ON INSURANCE, JANUARY 14, 2021

AN ACT

Amending the act of April 9, 1929 (P.L.177, No.175), entitled

"An act providing for and reorganizing the conduct of the

executive and administrative work of the Commonwealth by the

Executive Department thereof and the administrative

departments, boards, commissions, and officers thereof,

including the boards of trustees of State Normal Schools, or

Teachers Colleges; abolishing, creating, reorganizing or

authorizing the reorganization of certain administrative

departments, boards, and commissions; defining the powers and

duties of the Governor and other executive and administrative

officers, and of the several administrative departments,

boards, commissions, and officers; fixing the salaries of the

Governor, Lieutenant Governor, and certain other executive

and administrative officers; providing for the appointment of

certain administrative officers, and of all deputies and

other assistants and employes in certain departments, boards,

and commissions; providing for judicial administration; and

prescribing the manner in which the number and compensation

of the deputies and all other assistants and employes of

certain departments, boards and commissions shall be

determined," establishing the Office of Consumer Advocate for

Health Insurance as an office within the Office of Attorney

General and prescribing its powers and duties; and making

editorial changes.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Article IX-A of the act of April 9, 1929

(P.L.177, No.175), known as The Administrative Code of 1929, is

amended by adding a subarticle heading to read:

ARTICLE IX-A

OFFICE OF CONSUMER ADVOCATE

(a) Office of Consumer Advocate for

Public Utility Matters

Section 2. Section 901-A introductory paragraph of the act

is amended to read:

Section 901-A. Definitions.--As used in this [article]

subarticle:

* * *

Section 3. Article IX-A of the act is amended by adding a

subarticle to read:

(b) Office of Consumer Advocate

for Health Insurance

Section 921-A. Definitions.

The following words and phrases when used in this subarticle

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Consumer." A person who is a named insured, insured or

beneficiary of a policy of health insurance or any other person,

including employers who purchase insurance for themselves and

their employees, who may be affected in any way by the Insurance

Department's exercise of or the failure to exercise its

authority.

"Consumer Advocate." The Consumer Advocate for Health

Insurance serving as the head of the Office of Consumer Advocate

for Health Insurance under this subarticle.

"Department." The Insurance Department of the Commonwealth.

"Insurer." Any of the following:

(1) A "company," "association" or "exchange" as those

terms are defined in section 101 of the act of May 17, 1921

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(P.L.682, No.284), known as The Insurance Company Law of

1921.

(2) An entity subject to any of the following:

(i) 40 Pa.C.S. Ch. 61 (relating to hospital plan

corporations) or 63 (relating to professional health

services plan corporations).

(ii) Article XXIV of The Insurance Company Law of

1921.

(iii) The act of December 29, 1972 (P.L.1701,

No.364), known as the Health Maintenance Organization

Act.

Section 922-A. Office of Consumer Advocate for Health

Insurance.

(a) Office established.--There is hereby established as an

office within the Office of Attorney General an Office of

Consumer Advocate for Health Insurance to represent the

interests of consumers before the department.

(b) Consumer Advocate for Health Insurance.--The Office of

Consumer Advocate for Health Insurance shall be headed by the

Consumer Advocate for Health Insurance. The following apply:

(1) The Consumer Advocate shall be appointed by the

Attorney General and shall, by reason of training, experience

and attainment, be qualified to represent the interests of

consumers.

(2) The term of the Consumer Advocate shall be for six

years.

(3) No person shall serve as the Consumer Advocate for

more than two terms.

(4) Compensation for the Consumer Advocate shall be set

by the Executive Board, established under section 204.

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Consumer Advocate shall, while serving in the position, engage

in any business, vocation or other employment, or have other

interests, inconsistent with the official responsibilities, nor

shall the individual seek or accept employment nor render

beneficial services for compensation with an insurer subject to

the authority of the office during the tenure of the appointment

and for a period of two years immediately after the appointment

is served or terminated.

(d) Restriction.--Neither the Consumer Advocate nor an

employee of the Consumer Advocate shall be employed by or be

pecuniarily interested in an insurance company, association or

exchange, or in an insurance business, other than as a

policyholder.

(e) Political office.--An individual who is appointed to the

position of Consumer Advocate shall not seek election nor accept

appointment to a political office during the tenure as Consumer

Advocate and for a period of two years after the appointment is

served or terminated.

Section 923-A. Assistant consumer advocates for health

insurance and employees.

(a) Authorization.--The Consumer Advocate may:

(1) Appoint attorneys as assistant consumer advocates

for health insurance and additional clerical, technical and

professional staff as may be appropriate.

(2) Contract for additional services as shall be

necessary for the performance of the duties imposed by this

subarticle.

(b) Compensation.--The compensation of assistant consumer

advocates for health insurance and clerical, technical and

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professional staff shall be set by the Executive Board.

insurance or other staff employee shall, while serving in the

position, engage in a business, vocation or other employment, or

have other interests, inconsistent with official

responsibilities.

Section 924-A. Powers and duties of Consumer Advocate for

Health Insurance.

(a) Representation of consumer interests.--In addition to

other authority conferred by this subarticle, the Consumer

Advocate is authorized to and shall, in carrying out the

responsibilities under this subarticle, represent the interests

of consumers as a party, or otherwise participate for the

purpose of representing an interest of consumers, before the

department in a matter properly before the department, and

before a court or agency, initiating proceedings if, in the

judgment of the Consumer Advocate, the representation may be

necessary, in connection with a matter involving regulation by

the department or the corresponding regulatory agency of the

United States, whether on appeal or otherwise initiated.

(b) Exercise of discretion.--The Consumer Advocate may

exercise discretion in determining the interests of consumers

that will be advocated in a particular proceeding and in

determining whether to participate in or initiate a particular

proceeding. The following apply:

(1) In making a determination, the Consumer Advocate

shall consider the public interest, the resources available

and the substantiality of the effect of the proceeding on the

interests of consumers.

(2) The Consumer Advocate may refrain from intervening

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when, in the judgment of the Consumer Advocate, intervention

is not necessary to represent adequately the interests of

consumers.

money available from the Federal Government and may expend all

the money obtained from grant awards.

(d) Action on petition.--In addition to other authority

conferred by this subarticle, the Consumer Advocate is

authorized to represent an interest of consumers that is

presented for consideration upon petition in writing by a

substantial number of persons who are consumers of an insurer

subject to regulation by the department. The following apply:

(1) The Consumer Advocate shall notify the principal

sponsors of the petition within a reasonable time after

receipt of the petition of the action taken or intended to be

taken with respect to the interests of consumers presented in

that petition.

(2) If the Consumer Advocate declines or is unable to

represent the interests, written notification and the reasons

for the action shall be given to the sponsors.

(e) Name in which action is brought.--An action brought by

the Consumer Advocate before a court or an agency of this

Commonwealth shall be brought in the name of the Consumer

Advocate. The Consumer Advocate may name a consumer or group of

consumers in whose name the action may be brought or may join

with a consumer or group of consumers in bringing the action.

(f) Public statement.--At a time that the Consumer Advocate

determines, in accordance with applicable time limitations, to

initiate, intervene or otherwise participate in a department,

agency or court proceeding, the Consumer Advocate shall issue

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publicly a written statement, a copy of which shall be filed in

the proceeding in addition to a required entry of appearance,

stating concisely the specific interests of consumers to be

protected.

Section 925-A. Duties of department.

In dealing with a proposed action that may substantially

affect the interests of consumers, including a proposed change

of rates and the adoption of rules, regulations, guidelines,

orders, standards or final policy decisions, the department

shall:

(1) Notify the Consumer Advocate when notice of the

proposed action is given to the public or at a time fixed by

agreement between the Consumer Advocate and the department in

a manner to assure that the Consumer Advocate has reasonable

notice and adequate time to determine whether to intervene in

the matter.

(2) Consistent with its other statutory

responsibilities, take action with due consideration to the

interests of consumers.

Section 926-A. Reports.

(a) Transmittal and availability.--The Consumer Advocate

shall annually transmit to the Governor and to the chairperson

and minority chairperson of the Banking and Insurance Committee

of the Senate and the chairperson and minority chairperson of

the Insurance Committee of the House of Representatives, and

shall make available to the public, an annual report on the

conduct of the Office of Consumer Advocate.

(b) Recommendations.--The Consumer Advocate shall make

recommendations as may from time to time be necessary or

desirable to protect the interests of consumers.

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Section 927-A. Savings provision and construction.

(a) No bar to action.--Nothing contained in this subarticle

shall limit the right of a consumer to bring a proceeding before

either the department or a court.

(b) No impairment to department.--Nothing contained in this

subarticle shall be construed to impair the statutory authority

or responsibility of the department to regulate insurers in the

public interest.

Section 4. This act shall take effect in 60 days.

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