LEG REG REVIEW 2016, 17th Issue — October 24, 2016


2016, 18th Issue *** October 24, 2016


LEG REG REVIEW is a periodic newsletter produced by PHILLIPS ASSOCIATES, a professional lobbying and consultant firm located near the State Capitol.  It contains news on Pennsylvania legislation and regulations impacting the Insurance and Business Communities.  It is a free member benefit for those who are members of the Pennsylvania Association of Health Underwriters (PAHU).  Subscription information may be obtained by contacting PHILLIPS ASSOCIATES at 717/728-1217 FAX 717/232-7005 or e-mail to xenobun@aol.com.  Please email jtrout2792@aol.com supplying both your name and e-mail address if you wish to be removed from or added to this list. Whether it means meeting your CE need or helping with a particular problem/question, please visit our web site to explore how PHILLIPS ASSOCIATES may be of service to you, your employees and your clients.  www.vphillipsassoc.com 



Even though the legislative session is winding down, a number of insurance bills are seeing traction as they make their way through the legislative process.

  • LYFT/UBER: The House approved Senate Bill 984 (Bartolotta-R-Washington) by a 188-0 vote on October 19 and sent it back to the Senate for concurrence, which, if done, puts the bill on the Governor’s desk.  Background:  Transportation Network Services have become very popular as an alternative to traditional taxi service but their legal status is in question.  Most recently, the Philadelphia Parking Authority tried to prohibit Lyft/Uber operations because a short-term legislative authorization ran out.  Also, the Public Utility Commission (PUC) is seeking an $11 million fine for ride-sharing networks because they had operated for a time without the PUC’s OK.  The PUC had issued an experimental authorization but it was for only two years and needs action by the General Assembly to make Transportation Network Services fully legal in the state.
  • CLAIMS LOOK-BACK: The Senate Banking & Insurance Committee reported out House Bill 2241 (Boback-R-Luzerne/Wyoming/Lackawanna).  This limits a health insurer’s ability to go back for more than two years in assessing past claims reimbursements to health care providers.  If the Senate votes for it without amending it, HB 2241 goes to the Governor for his signature.  Background:  A long-standing issue for some health care providers has been demands from carriers to health care providers to reimburse claims over an extended period of many years when concluding that the reimbursement were improperly made.


On October 19, the Senate Banking & Insurance Committee convened a hearing on what is known as balance billing.  This happens when a patient receives treatment from an in-network provider which contracts some services to non-network providers such as anesthesiologists.  The non-network providers receive less reimbursement from health insurers and the patient receives a ‘surprise’ billing for a larger amount, sometimes in the thousands of dollars.  Testifying was Insurance Commissioner Teresa Miller who had held an Insurance Department hearing on the same issue.  She commended Senator Judy Schwank (D-Berks) for her sponsorship of Senate Bill 1158 which would require all treatments performed to be considered in-network if the original provider such as a hospital was in-network.


Testifier Berks County insurance agent Jay Mahoney of Gallen Insurance injected a new argument that the Patient Protection Affordable Care Act (PPACA) requires zero payment by insureds for certain preventive care such as mammograms.  He said that when the exam is performed, results are often assessed by other health care providers which may be non-network who then charge the patient for the non-network treatment. He said that PPACA prohibits those extra providers from billing patients.  Also testifying were health care providers and insurers.






The Senate Banking & Insurance Committee holds a hearing this week on two prescription drug bills.  Senate Bill 842 (Mensch-R-Montgomery/Berks/Bucks) would allow exemptions to Rx tiered pricing if the prescribing physician determines that a non-preferred drug is more effective in treating the patient’s condition than the preferred drug.  The second exemption would occur if the preferred drug is found to have adverse effects on the patient.  The second bill is Senate Bill 893 (White-R-Indiana) which would establish the Pharmaceutical Transparency Commission which, according to Senator White’s sponsorship memo says that the Commission would be established to educate consumers and payers about Rx drug costs to ensure they are pricing reasonably in relation to cost. Members of the Commission would be:

  • Insurance Commissioner
  • Secretary of the Department of Human Services (formerly DPW)
  • Pharmacist designated by the PA Pharmacist Association
  • Consumer advocate nominated by the Leukemia/Lymphoma Society
  • Physician recommended by PA Medical Society
  • Insurance producer designated by the PA Association of Health Underwriters


On October 22, the PA Bulletin published the list of Insurance Department approved guides for assessing the value of total loss or unrecovered vehicles under the authority of the Motor Vehicle Physical Damage Appraisal Act.  Details: https://www.pabulletin.com/secure/data/vol46/46-43/1831.html



  • House Insurance Committee hearing on two bills relating to autism. House Bill 1559 (Murt-R-Montgomery) and House Bill 2010 (Quinn-R-Bucks) create a new graduate behavior specialist license to allow those with Master’s degrees to work under the supervision of a licensed provider while gaining the work experience they need in order to be fully licensed.
  • Senate Appropriations Committee consideration of Senate Bill 1331 (Reschenthaler-R-Allegheny/Washington) which would permit sales of travel insurance without having an insurance license. Also being considered is House Bill 1403 (Quinn-R-Bucks) requiring life insurance companies to do a better job of locating beneficiaries by utilizing the Social Security Master death List.
  • House Judiciary Committee informational meeting on Act 16 of 2016 (Medical Marijuana)
  • Insurance Commissioner Miller and Rep. Marguerite Quinn (R-Bucks) are holding a press conference announcing that the Insurance Department will have a new service per Rep. Quinn’s House Bill 2115. This service helps people track down an insurance company which may be able to pay a ‘lost’ claim.  Often, someone dies and leaves an obscure life insurance policy for a carrier which may have been bought up by someone else.  The Insurance Department would help locate that carrier.

INSURANCE DEPARTMENT UPDATES:  Insurance Department announced 2017 rates for individual and small group offered in PA under the Patient Protection Affordable Care Act (PPACA) https://www.insurance.pa.gov/Consumers/HealthInsuranceFilings/Pages/default.aspx ; Insurance Commissioner received the Pink Ribbon Award from the Breast Cancer Coalition for the Insurance Department Notice requiring insurer to cover 3-D (density) mammograms; Education Secretary Pedro Rivera and Insurance Commissioner announced an Internet interactive  teaching curriculum on auto insurance called ‘Insurance 101. This teacher resource is available from the PA Education Department’s web site at https://www.pdesas.org/ContentWeb/Content/Content/30001/Web-based%20Resource

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