PRINTER'S NO. 955
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
947
Session of
2021
INTRODUCED BY ZIMMERMAN, MILLARD, JAMES, JOZWIAK, GLEIM, MOUL,
DRISCOLL, KEEFER, R. BROWN, FREEMAN, BURGOS, RADER, GAYDOS,
JONES AND IRVIN, MARCH 17, 2021
REFERRED TO COMMITTEE ON INSURANCE, MARCH 17, 2021
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for furnishing claims experience to policyholders.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 621.6. Furnishing Claims Experience to
Policyholders.--(a) Subject to the other provisions of this
section, each insurer shall furnish, regardless of the rating
methodology used, claims experience to group policyholders
within thirty days of a policyholder's request unless the
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information has been furnished to the group policyholder within
the preceding six months.
(b) Claims experience shall be furnished for all groups of
fifty-one or more covered employes, members or enrollees, not
including dependents.
(c) Claims experience shall include the following:
(1) Earned premiums separated by policy year for at least
the last two policy years, if applicable.
(2) Total paid claims and total incurred claims, inclusive
of any high amount or pooled claims, including both capitated
and noncapitated expenses specified in the same manner as
premiums.
(3) Any amounts in excess of the individual pooling or stop-
loss point applicable to the group.
(d) An insurer that utilizes provider contracting methods,
including financial devices such as global fee arrangements, to
cover all medical expenses may apply to the commissioner for
approval of the use of an alternative form of claims experience
reporting. The following shall apply:
(1) The insurer shall provide Commonwealth experience on a
group-specific basis or on another reasonable basis as the
commissioner may approve for the insurer, in advance, based upon
a submission of an explanation and supporting documentation.
(2) An insurer that received approval for an alternative
form of group claims experience reporting to policyholders shall
be required to seek the commissioner's advance approval of a
proposed response letter to group policyholders who request
experience reporting. The letter shall describe the insurer's
reasons for seeking an alternative reporting process and
describe the alternative form of reporting approved by the
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commissioner.
(e) An insurer may charge a reasonable fee for providing the
information under this section to group policyholders. The
schedule or amount of fees to be charged to group policyholders
for providing the information shall be filed by each insurer
with the commissioner.
(f) In providing claims experience to group policyholders
under this section, an insurer shall adhere to all Federal and
State laws regarding disclosure of protected health or personal
information.
(g) As used in this section:
"Commissioner" means the Insurance Commissioner of the
Commonwealth.
"Insurer" means an entity licensed by the Insurance
Department with accident and health authority to issue a policy,
subscriber contract, certificate or plan that provides medical
or health care coverage, including emergency services, and is
offered or governed under any of the following:
(1) This act, including section 630 and Article XXIV.
(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) or 63 (relating to professional health services
plan corporations).
Section 2. This act shall take effect in 60 days.
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