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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY MATZIE, BARBIN, D. COSTA, SABATINA, BRIGGS, CALTAGIRONE, DEASY, FABRIZIO, GIBBONS, HORNAMAN, JOHNSON, JOSEPHS, KORTZ, KOTIK, KULA, MUNDY, MURT, M. O'BRIEN, READSHAW, ROSS, K. SMITH, STABACK, STURLA, THOMAS, WAGNER AND YOUNGBLOOD, FEBRUARY 16, 2011 |
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| REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 16, 2011 |
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| AN ACT |
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1 | Amending the act of April 9, 1929 (P.L.177, No.175), entitled |
2 | "An act providing for and reorganizing the conduct of the |
3 | executive and administrative work of the Commonwealth by the |
4 | Executive Department thereof and the administrative |
5 | departments, boards, commissions, and officers thereof, |
6 | including the boards of trustees of State Normal Schools, or |
7 | Teachers Colleges; abolishing, creating, reorganizing or |
8 | authorizing the reorganization of certain administrative |
9 | departments, boards, and commissions; defining the powers and |
10 | duties of the Governor and other executive and administrative |
11 | officers, and of the several administrative departments, |
12 | boards, commissions, and officers; fixing the salaries of the |
13 | Governor, Lieutenant Governor, and certain other executive |
14 | and administrative officers; providing for the appointment of |
15 | certain administrative officers, and of all deputies and |
16 | other assistants and employes in certain departments, boards, |
17 | and commissions; and prescribing the manner in which the |
18 | number and compensation of the deputies and all other |
19 | assistants and employes of certain departments, boards and |
20 | commissions shall be determined," establishing the Office of |
21 | Consumer Advocate for Health Insurance as an office within |
22 | the Office of Consumer Advocate and prescribing its powers |
23 | and duties; and making editorial changes. |
24 | The General Assembly of the Commonwealth of Pennsylvania |
25 | hereby enacts as follows: |
26 | Section 1. Article IX-A of the act of April 9, 1929 (P.L. |
27 | 177, No.175), known as The Administrative Code of 1929, is |
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1 | amended by adding a subarticle heading to read: |
2 | ARTICLE IX-A |
3 | OFFICE OF CONSUMER ADVOCATE |
4 | (a) General Provisions |
5 | Section 2. Article IX-A of the act is amended by adding a |
6 | subarticle to read: |
7 | (b) Office of Consumer Advocate |
8 | for Health Insurance |
9 | Section 921-A. Definitions. |
10 | The following words and phrases when used in this subarticle |
11 | shall have the meanings given to them in this section unless the |
12 | context clearly indicates otherwise: |
13 | "Consumer." A person who is a named insured, insured or |
14 | beneficiary of a policy of health insurance or any other person, |
15 | including employers who purchase insurance for themselves and |
16 | their employees, who may be affected in any way by the Insurance |
17 | Department's exercise of or the failure to exercise its |
18 | authority. |
19 | "Department." The Insurance Department of the Commonwealth. |
20 | "Insurer." Any "company," "association" or "exchange" as |
21 | such terms are defined in section 101 of the act of May 17, 1921 |
22 | (P.L.682, No.284), known as The Insurance Company Law of 1921 or |
23 | any entity subject to 40 Pa.C.S. Ch. 61 (relating to hospital |
24 | plan corporations) or 63 (relating to professional health |
25 | services plan corporations) or Article XXIV of The Insurance |
26 | Company Law of 1921 or the act of December 29, 1972 (P.L.1701, |
27 | No.364), known as the Health Maintenance Organization Act. |
28 | Section 922-A. Office of Consumer Advocate for Health |
29 | Insurance. |
30 | (a) Office established.--There is hereby established as an |
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1 | office within the Department of Community and Economic |
2 | Development an Office of Consumer Advocate for Health Insurance |
3 | to represent the interests of consumers before the department. |
4 | (b) Consumer Advocate for Health Insurance.--The Office of |
5 | Consumer Advocate for Health Insurance shall be headed by the |
6 | Consumer Advocate for Health Insurance appointed by the Governor |
7 | who by reason of training, experience and attainment is |
8 | qualified to represent the interests of consumers. The term of |
9 | the Consumer Advocate shall be for six years, and no person |
10 | shall serve for more than two terms. Compensation shall be set |
11 | by the Executive Board, established under section 204. |
12 | (c) Conflict of interest.--No individual who serves as a |
13 | Consumer Advocate for Health Insurance shall, while serving in |
14 | the position, engage in any business, vocation or other |
15 | employment, or have other interests, inconsistent with the |
16 | official responsibilities, nor shall the individual seek or |
17 | accept employment nor render beneficial services for |
18 | compensation with any insurer subject to the authority of the |
19 | office during the tenure of the appointment and for a period of |
20 | two years immediately after the appointment is served or |
21 | terminated. |
22 | (d) Restriction.--Neither the Consumer Advocate for Health |
23 | Insurance nor an employee of the Consumer Advocate shall be |
24 | employed by or be pecuniarily interested in any insurance |
25 | company, association or exchange, or in any insurance business, |
26 | other than as a policyholder. |
27 | (e) Political office.--Any individual who is appointed to |
28 | the position of Consumer Advocate for Health Insurance shall not |
29 | seek election nor accept appointment to any political office |
30 | during the tenure as Consumer Advocate for Health Insurance and |
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1 | for a period of two years after the appointment is served or |
2 | terminated. |
3 | Section 923-A. Assistant consumer advocates for health |
4 | insurance; employees. |
5 | The Consumer Advocate for Health Insurance may appoint |
6 | attorneys as assistant consumer advocates for health insurance |
7 | and additional clerical, technical and professional staff as may |
8 | be appropriate, and may contract for additional services as |
9 | shall be necessary for the performance of the duties imposed by |
10 | this subarticle. The compensation of assistant consumer |
11 | advocates for health insurance and clerical, technical and |
12 | professional staff shall be set by the Executive Board. No |
13 | assistant consumer advocate for health insurance or other staff |
14 | employee shall, while serving in the position, engage in any |
15 | business, vocation or other employment, or have other interests, |
16 | inconsistent with official responsibilities. |
17 | Section 924-A. Powers and duties of Consumer Advocate for |
18 | Health Insurance. |
19 | (a) Representation of consumer interests.--In addition to |
20 | any other authority conferred by this subarticle, the Consumer |
21 | Advocate for Health Insurance is authorized to and shall, in |
22 | carrying out the responsibilities under this subarticle, |
23 | represent the interests of consumers as a party, or otherwise |
24 | participate for the purpose of representing an interest of |
25 | consumers, before the department in any matter properly before |
26 | the department, and before any court or agency, initiating |
27 | proceedings if, in the judgment of the Consumer Advocate for |
28 | Health Insurance, the representation may be necessary, in |
29 | connection with any matter involving regulation by the |
30 | department or the corresponding regulatory agency of the United |
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1 | States, whether on appeal or otherwise initiated. |
2 | (b) Exercise of discretion.--The Consumer Advocate for |
3 | Health Insurance may exercise discretion in determining the |
4 | interests of consumers that will be advocated in any particular |
5 | proceeding and in determining whether to participate in or |
6 | initiate any particular proceeding. In making a determination, |
7 | the Consumer Advocate for Health Insurance shall consider the |
8 | public interest, the resources available and the substantiality |
9 | of the effect of the proceeding on the interests of consumers. |
10 | The Consumer Advocate for Health Insurance may refrain from |
11 | intervening when, in the judgment of the Consumer Advocate for |
12 | Health Insurance, intervention is not necessary to represent |
13 | adequately the interests of consumers. |
14 | (c) Grants.--The Consumer Advocate for Health Insurance |
15 | shall apply for all grant moneys available from the Federal |
16 | Government through the Patient Protection and Affordable Care |
17 | Act (Public Law 111-148, 124 Stat. 119) and other related laws |
18 | and may expend all the moneys obtained from grant awards. |
19 | (d) Action on petition.--In addition to any other authority |
20 | conferred by this subarticle, the Consumer Advocate for Health |
21 | Insurance is authorized to represent an interest of consumers |
22 | that is presented for consideration upon petition in writing by |
23 | a substantial number of persons who are consumers of an insurer |
24 | subject to regulation by the department. The Consumer Advocate |
25 | for Health Insurance shall notify the principal sponsors of the |
26 | petition within a reasonable time after receipt of the petition |
27 | of the action taken or intended to be taken with respect to the |
28 | interests of consumers presented in that petition. If the |
29 | Consumer Advocate for Health Insurance declines or is unable to |
30 | represent the interests, written notification and the reasons |
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1 | for the action shall be given to the sponsors. |
2 | (e) Name in which action is brought.--Any action brought by |
3 | the Consumer Advocate for Health Insurance before a court or an |
4 | agency of this Commonwealth shall be brought in the name of the |
5 | Consumer Advocate for Health Insurance. The Consumer Advocate |
6 | for Health Insurance may name a consumer or group of consumers |
7 | in whose name the action may be brought or may join with a |
8 | consumer or group of consumers in bringing the action. |
9 | (f) Public statement.--At a time that the Consumer Advocate |
10 | for Health Insurance determines, in accordance with applicable |
11 | time limitations, to initiate, intervene or otherwise |
12 | participate in any department, agency or court proceeding, the |
13 | Consumer Advocate for Health Insurance shall issue publicly a |
14 | written statement, a copy of which shall be filed in the |
15 | proceeding in addition to any required entry of appearance, |
16 | stating concisely the specific interests of consumers to be |
17 | protected. |
18 | Section 925-A. Duties of department. |
19 | In dealing with any proposed action that may substantially |
20 | affect the interests of consumers, including, but not limited |
21 | to, a proposed change of rates and the adoption of rules, |
22 | regulations, guidelines, orders, standards or final policy |
23 | decisions, the department shall: |
24 | (1) Notify the Consumer Advocate for Health Insurance |
25 | when notice of the proposed action is given to the public or |
26 | at a time fixed by agreement between the Consumer Advocate |
27 | for Health Insurance and the department in a manner to assure |
28 | the Consumer Advocate for Health Insurance reasonable notice |
29 | and adequate time to determine whether to intervene in the |
30 | matter. |
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1 | (2) Consistent with its other statutory |
2 | responsibilities, take action with due consideration to the |
3 | interests of consumers. |
4 | Section 926-A. Reports. |
5 | The Consumer Advocate for Health Insurance shall annually |
6 | transmit to the Governor and to the General Assembly, and shall |
7 | make available to the public, an annual report on the conduct of |
8 | the Office of Consumer Advocate for Health Insurance. The |
9 | Consumer Advocate for Health Insurance shall make |
10 | recommendations as may from time to time be necessary or |
11 | desirable to protect the interests of consumers. |
12 | Section 927-A. Savings provision and construction. |
13 | (a) No bar to action.--Nothing contained in this subarticle |
14 | shall limit the right of a consumer to bring a proceeding before |
15 | either the department or a court. |
16 | (b) No impairment to department.--Nothing contained in this |
17 | subarticle shall be construed to impair the statutory authority |
18 | or responsibility of the department to regulate insurers in the |
19 | public interest. |
20 | Section 3. This act shall take effect in 60 days. |
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