LEG REG REVIEW 2017, 28th Issue August 31st, 2017

As you know, I chose not to renew my contract with the PA Association of Health Underwriters (PAHU) effective July 1 as I begin scaling back my lobbying activities toward eventual retirement.  Part of my contract since 2003 has been to provide LEG REG Review to PAHU as a value-added member benefit.  Ordinarily, this publication subscription is $100.00 per year.  What this means is that PAHU members wishing to receive LEG REG Review will need to subscribe UNLESS THEY ARE MEMBERS OF GPAHU.  By special arrangement, GPAHU members will still continue to receive LEG REG Review at least through December 2017 at no cost to them.  If you find this newsletter to be of help in keeping you abreast of legislative and regulatory developments that affect insurance brokers and their clients, I ask that you subscribe.  I look forward to hearing from you.
Sincerely, Vince Phillips
On September 6, PA Acting Insurance Commissioner Jessica Altman and commissioners from Tennessee, Washington, Alaska, and Oklahoma will testify before the U.S. Senate Health, Education, Labor, & Pensions Committee in Washington, DC on ways to stabilize Affordable Care Act exchanges.  Their focus is expected to be a plea for the Federal Government not to reduce or eliminate its financial support to carriers.  On July 31, former PA Insurance Commissioner Teresa Miller wrote to HHS Secretary Tom Price to warn of dire consequences to Pennsylvanians if the Federal Government does not come through in paying insurance companies under the Affordable Care Act’s “cost-sharing” or market stabilization payments.  She said that premiums would bump up to a statewide increase of 20.3 percent rather than the 8.8 percent statewide average filed with the Department in May.

The Pennsylvania Insurance Department listed four regulations on which it is working. (August 19, 2017 PA Bulletin ,Page 4942, www.pabulletin.com )

  • Medicare Supplement —NAIC Model Regulation update

Fall 2017, as Proposed
Amendments to Chapter 89 based upon NAIC Model amendments.

  • Health Insurance Reserves — NAIC Model Regulation

Winter 2018, Proposed Amendments to Chapter 84a based upon NAIC Model amendments.

  • Transportation Network Company Endorsements

Fall 2017, proposed amendments to Chapter 113 regarding ‘‘Cancellation or Nonrenewal of Policies Containing Transportation Network Company Endorsements.’’

  • Privacy and Opt Out Notices for Financial Information —NAIC Model Regulation update

Fall 2017, proposed amendments to Chapter 146a in accordance with NAIC model regulation # 672 regarding requirements for annual privacy policy notices.

Details: Insurance Department Regulatory Coordinator: Bridget E. Burke (717) 787-2567
The PA Insurance Department released a brochure to help consumers better understand coverage by insurers for substance abuse treatment.  This was presented as part of the Wolf Administration’s efforts to battle the opioid crisis.  The brochure specifically addresses substance abuse disorder treatment (SUD) and says:

  • A person enrolled in Medicaid has that coverage
  • A person with an individual health policy secured via an insurance agent or through healthcare.gov is covered as long as the plan meets Affordable Care Act requirements.
  • An employee having employer-offered insurance is covered.
  • An employee working for a firm which is self-insured may or may not provide this coverage as it is not legally mandated for these plans.

While specific plans may differ as to specific items of coverage, all must meet “parity” rules.  This means that an insurance plan must offer the same level of benefits for SUD as it does for medical and surgical benefits.  Examples of parity areas are number of outpatient visits, out-of-pocket costs such as co-pays/ deductibles/co-insurance, prior authorizations for treatment, and criteria to determine medical necessity.

On August 25, the PA Compensation Rating Bureau (PCRB) submitted a loss cost filing change for Workers’ Compensation insurance calling for a uniform 6.06% increase applied uniformly for almost all class codes.  If approved, the filing would be effective November 1, 2017.  According to PCRB Circulars Number 1683, 1685 and 1686, the filing responded to the PA Supreme Court ruling in Protz v. Derry Area School District.  The Supreme Court struck down a provision in Act 57 of 1996 that attempted to rein in medical Workers’ Compensation costs by requiring physicians to apply methodology found in the latest American Medical Association Guides to the Evaluation of Permanent Impairment.  The court ruling said that this was unconstitutional because it bypasses the authority of the General Assembly.  PCRB questions: Bonnie Piacentino 215-320-4456.  Insurance Department contact for comment submission: Eric Zhou gzhou@pa.gov   A link to the PCRB filing follows:  https://pcrb.com/shared/p_contents.htm


  • On August 29, the PA Insurance Department introduced availability of a consumer flyer to help homeowners get the claim history of their property.  It also explores Flood Insurance options including the surplus lines private sector non-National Flood Insurance Program (NFIP) polcy.
  • On September 14, the Independent Regulatory Review Commission (IRRC) will meet to review Department of Banking & Securities Regulations Omnibus Amendments (Reg. No. 3-54)

HEALTH INSURANCE MARKET NEWS… Mark Farrah Associates released commercial health insurance analysis by market share for 2016 for these markets:

  • Philadelphia Metro — Independence Blue Cross with 57.9%, Aetna with 32.5%, UnitedHealth with 6.6%, and Cigna with 2.5%.
  • Harrisburg Metro – Capital Blue Cross with 46.4%, Aetna with 40.7%, UnitedHealth with 4.9%, Cigna with 3.8%, Geisinger with 2.6%
  • Pittsburgh Metro – Highmark with 71.8%, UPMC with 20.1%, UnitedHealth with 4.4%, Cigna with 2.8%, and Aetna with 1.0%(Thanks to IFAwebnews.com)

PERSONNEL…Alison Beam is returning to the PA Insurance Department, this time as Chief of Staff to Acting Commissioner Jessica Altman.  In the Corbett Administration, she served as Policy Director for the Department…PennDOT Secretary Leslie Richards has assumed an additional role as Chair of the PA Turnpike Commission…Former Senator John Wozniak (D-Cambria) was named to the Turnpike Commission.

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