SB 373 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in uniform health insurance claim form, further providing for forms for health insurance claims.

PRIOR PRINTER'S NO.

364 PRINTER'STHE NO.GENERAL ASSEMBLY OF PENNSYLVANIA SENATE BILL Session of No.

1287373 THE2017 GENERALINTRODUCED ASSEMBLYBY OFEICHELBERGER, PENNSYLVANIAGREENLEAF, SENATEREGAN, BILLRAFFERTY, SessionCOSTA, BREWSTER, BROWNE, ARGALL, MENSCH, WARD, VOGEL AND BOSCOLA, FEBRUARY 15, 2017 REFERRED TO BANKING AND INSURANCE, FEBRUARY 15, 2017 AN ACT Amending the act of No.May 17, 1921 (P.L.682, No.284), entitled "An act relating to insurance;

373amending, 2017revising, INTRODUCEDand BY EICHELBERGER, GREENLEAF, REGAN, RAFFERTY, COSTA, BROWNE, ARGALL, MENSCH, WARD, VOGEL, BOSCOLA, RESCHENTHALER, HUTCHINSON, SCAVELLO, KILLION, BROOKS, AUMENT, McGARRIGLE, STEFANO, ALLOWAY AND BLAKE, FEBRUARY 15, 2017 SENATOR WHITE, BANKING AND INSURANCE, AS AMENDED, OCTOBER 24, 2017 AN ACT Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An 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;

20170SB0373PN1287 - 2 - (2) An insurer may request departmental approval of 20170SB0373PN0364 - 2 - additional information requests to be printed in the blank spaces on the uniform claim form, and on subsequent pages if necessary, by submitting a written request to the department.

The insurance contract <-- INSURANCE CONTRACTS ISSUED 120 DAYS AFTER THE EFFECTIVE DATE OF <-- THIS ACT may not prohibit, and claim forms ISSUED AFTER THAT <-- DATE must provide an option for, the payment of benefits directly to the specified provider of the dental service.

THE(d) DENTALIn CLAIMthe FORMcase SHALLof CLEARLYvision ANDand CONSPICUOUSLYdental <--claim STATEforms WHETHERand THEin PROVIDERthe SEEKINGcase AUTHORIZATIONof FORsupplemental DIRECTmajor PAYMENTmedical FROMclaim THEforms, INSURERutilization WILLof BILLthe THEuniform PATIENTclaim FORform ANYshall BALANCEbe ABOVEat THEthe DIRECTdiscretion PAYMENTof ASSIGNEDthe TOindividual THEinsurer. PROVIDER.

THE INSURED MAY BE REQUIRED TO PAY ANY APPLICABLE COPAYMENTS, COINSURANCES OR DEDUCTIBLES AT THE TIME OF SERVICE, HOWEVER, THE PROVIDER SHALL NOT REQUIRE THE INSURED TO PAY ANY OTHER AMOUNT ABOVE THE DIRECT PAYMENT ASSIGNED TO THE PROVIDER AT THE POINT OF SERVICE.

(d) In the case of vision and dental claim forms and in the 20170SB0373PN1287 - 3 - case of supplemental major medical claim forms, utilization of the uniform claim form shall be at the discretion of the individual insurer.

(1) The costs and benefits associated with the direct reimbursement of nonparticipating providers by health insurance carriers under a valid agreement ASSIGNMENT of benefits.

<-- (2) The impact on consumers of prohibiting health insurance carriers from refusing to accept a valid assignment of benefits.

20170SB0373PN0364 - 3 - (3) The impact of requiring direct reimbursement of nonparticipating providers by health insurance carriers on a health insurance carrier's ability to maintain an adequate number of providers in their network.

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