Bill Text: PA HB2514 | 2009-2010 | Regular Session | Introduced

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Bill Title: Providing for the Pennsylvania Health Insurance Plan for uninsurable individuals.

Spectrum: Strong Partisan Bill (Democrat 16-1)

Status: (Introduced - Dead) 2010-05-17 - Referred to INSURANCE [HB2514 Detail]

Download: Pennsylvania-2009-HB2514-Introduced.html

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PRINTER'S NO. 3743
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2514 Session of2010
INTRODUCED BY KOTIK, DeLUCA, PASHINSKI, MANDERINO, DePASQUALE, HARKINS, LONGIETTI, McILVAINE SMITH, MUNDY, MURPHY, PAYTON, PRESTON, READSHAW, SHAPIRO, SIPTROTH, WANSACZ AND YUDICHAK, MAY 17, 2010
REFERRED TO COMMITTEE ON INSURANCE, MAY 17, 2010
AN ACT
Providing for the Pennsylvania Health Insurance Plan for
uninsurable individuals.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Health Plan
for Uninsurable Individuals Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Board." The board of directors of the plan.
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Creditable coverage." Creditable coverage as defined in
section 2701(c)(1) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936).
"Department." The Insurance Department of the Commonwealth.
"Dependent." A resident spouse or resident unmarried child
under 19 years of age, a child who is a student under 26 years
of age and who is dependent upon the parent or a child of any
age who is disabled and dependent upon the parent.
"Group health plan." An employee welfare benefit plan as
defined in section 3(1) of the Employee Retirement Income
Security Act of 1974 (Public Law 93-406, 88 Stat. 829) to the
extent that the plan provides medical care, as defined in
subsection (n) of the Employee Retirement Income Security Act of
1974, and including items and services paid for as medical care
to employees or their dependents as defined under the terms of
the plan directly or through insurance, reimbursement or
otherwise.
"Health insurance coverage."
(1) A hospital and medical expense incurred policy,
nonprofit health care service plan contract, health
maintenance organization subscriber contract or another
health care plan or arrangement that pays for or furnishes
medical or health care services whether by insurance or
otherwise.
(2) The term shall not include one or more or any
combination of the following:
(i) Coverage only for accident or disability income
insurance, or any combination thereof.
(ii) Coverage issued as a supplement to liability
insurance.
(iii) Liability insurance, including general
liability insurance and automobile liability insurance.
(iv) Workers' compensation or similar insurance.
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(v) Automobile medical payment insurance.
(vi) Credit-only insurance.
(vii) Coverage for onsite medical clinics.
(viii) Other similar insurance coverage, specified
in Federal regulations issued under the Health Insurance
Portability and Accountability Act of 1996 (Public Law
104-191, 110 Stat. 1936) under which benefits for medical
care are secondary or incidental to other insurance
benefits.
(3) The term shall shall not include the following
benefits if they are provided under a separate policy,
certificate or contract of insurance or are otherwise not an
integral part of the coverage:
(i) limited scope dental or vision benefits;
(ii) benefits for long-term care, nursing home care,
home health care, community-based care or any combination
thereof; or
(iii) other similar, limited benefits specified in
Federal regulations issued under the Health Insurance
Portability and Accountability Act of 1996.
(4) The term shall shall not include the following
benefits if the benefits are provided under a separate
policy, certificate or contract of insurance. There is no
coordination between the provision of the benefits and any
exclusion of benefits under any group health plan maintained
by the same plan sponsor, and the benefits are paid with
respect to an event without regard to whether benefits are
provided with respect to such an event under any group
health plan maintained by the same plan sponsor:
(i) coverage only for a specified disease or
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illness; or
(ii) hospital indemnity or other fixed indemnity
insurance.
(5) The term shall not include the following certificate
or contract of insurance if offered as a separate policy:
(i) Medicare supplemental health insurance as
defined under section 1882(g)(1) of the Social Security
Act (49 Stat. 620, 42 U.S.C. § 1882(g)(1));
(ii) coverage supplemental to the coverage provided
under Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS); or
(iii) similar supplemental coverage provided to
coverage under a group health plan.
"Health maintenance organization." An entity licensed and
regulated under the act of December 29, 1972 (P.L.1701, No.364)
known as the Health Maintenance Organization Act.
"Hospital." An entity licensed as a hospital under the act
of June 13, 1967 (P.L.31, No.21), known as the Public Welfare
Code, or the act of July 19, 1979 (P.L.130, No.48,) known as the
Health Care Facilities Act.
"Insurer." A company or health insurance entity licensed in
this Commonwealth to issue an individual or group health,
sickness or accident policy or subscriber contract or
certificate or plan that provides medical or health care
coverage by a health care facility or licensed health care
provider that is offered or governed under this act or the
following:
(1) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(2) The act of May 18, 1976 (P.L.123, No.54), known as
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the Individual Accident and Sickness Insurance Minimum
Standards Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
"Medical care." Amounts paid for:
(1) the diagnosis, care, mitigation, treatment or
prevention of disease, or amounts paid for the purpose of
affecting any structure or function of the body;
(2) transportation primarily for and essential to
medical care referred to in paragraph (1); and
(3) Insurance covering medical care referred to in
paragraphs (1) and (2).
"Medicare." Coverage under both Parts A and B of Title XVIII
of the Social Security Act (Public Law 74-271, 42 U.S.C. § 1395
et seq.).
"Participating insurer." An insurer providing health
insurance coverage to residents of this Commonwealth.
"Plan." The Pennsylvania Health Insurance Plan established
in section 3.
"Plan of operation." The articles, bylaws and operating
rules and procedures adopted by the board under section 3.
"Preexisting condition." A condition for which medical
advice, care or treatment was recommended or received during the
six months prior to the effective date of coverage under the
plan.
"Producer." A person required to be licensed under the laws
of this Commonwealth to sell, solicit or negotiate insurance.
"Resident." Any of the following:
(1) An individual who has been legally domiciled in this
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Commonwealth for a minimum of 90 days.
(2) An individual who is legally domiciled in this
Commonwealth and is eligible for enrollment in the pool as a
result of the Health Insurance Portability and Accountability
Act of 1996 (Public Law 104-191, 110 Stat. 1936).
(3) An individual who is legally domiciled in this
Commonwealth and is eligible for enrollment as a result of
the Trade Adjustment Assistance Reform Act of 2002 (Public
Law 107-210, 116 Stat. 933).
"Significant break in coverage." A period of 63 consecutive
days during which the individual does not have creditable
coverage except that neither a waiting period nor an affiliation
period is taken into account in determining a significant break
in coverage.
Section 3. Plan.
(a) Establishment.--There is established the Pennsylvania
Health Insurance Plan.
(b) Operation.--The plan shall operate subject to the
supervision and control of the board.
(c) Board composition.--The board shall consist of:
(1) One representative of a domestic insurance company
appointed by the President pro tempore of the Senate from a
list supplied by the Insurance Federation of Pennsylvania,
Inc., or its successor.
(2) One representative of a domestic insurance company
appointed by the Speaker of the House of Representatives from
a list supplied by the Insurance Federation of Pennsylvania,
Inc., or its successor.
(3) One representative of a nonprofit health care
service plan appointed by the President pro tempore of the
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Senate.
(4) One representative of a health maintenance
organization appointed by the Speaker of the House of
Representatives.
(5) One member representing the medical provider
community, such as a physician licensed to practice medicine
in this Commonwealth or a hospital administrator appointed by
the Secretary of Health from lists supplied by the
Pennsylvania Medical Society, or its successor, and the
Hospital & Healthsystem Association of Pennsylvania, or its
successor.
(6) Five members of the general public who are not
employed by or affiliated with an insurance company or plan,
group hospital or other health care provider and are not
reasonably expected to qualify for coverage in the pool, with
one appointment by each of the following: the Majority Leader
of the Senate, the Minority Leader of the Senate, the
Majority Leader of the House of Representatives, the Minority
Leader of the House of Representatives and the Insurance
Commissioner.
No elected official may be a member of the board.
(d) Terms of board members.--The original members of the
board shall be appointed for the following terms:
(1) Four members for a term of one year.
(2) Three members for a term of two years.
(3) Three members for a term of three years.
(4) All terms after the initial term shall be for three
years.
(e) Chairman.--The board shall elect one of its members as
chairman, who may serve in that capacity only for two years.
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(f) Reimbursement of expenses.--Members of the board may be
reimbursed from moneys of the pool for actual and necessary
expenses incurred by them in the performance of their official
duties as members of the board but shall not otherwise be
compensated for their services.
(g) Plan of operation.--The board shall submit to the
commissioner a plan of operation for the plan and any amendments
thereto necessary or suitable to assure the fair, reasonable and
equitable administration of the plan. The plan of operation
shall become effective upon approval in writing by the
commissioner consistent with the date on which the coverage
under this act must be made available. If the board fails to
submit a suitable plan of operation within 180 days after the
appointment of the board, or at any time thereafter fails to
submit suitable amendments to the plan of operation, the
commissioner shall adopt and promulgate such rules as are
necessary or advisable to effectuate the provisions of this
section. Such rules shall continue in force until modified by
the commissioner or superseded by a plan of operation submitted
by the board and approved by the commissioner.
(h) Plan of operation requirements.--The plan of operation
shall:
(1) Establish procedures for operation of the plan.
(2) Establish procedures for selecting an administrator
in accordance with section 6.
(3) Establish procedures to create a fund, under
management of the board, for administrative expenses.
(4) Establish procedures for the handling, accounting
and auditing of assets, moneys and claims of the plan and the
plan administrator.
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(5) Develop and implement a program to publicize the
existence of the plan, its eligibility requirements and
procedures for enrollment and to maintain public awareness of
the plan.
(6) Establish procedures under which applicants and
participants may have grievances reviewed by a grievance
committee appointed by the board. The grievances shall be
reported to the board after completion of the review. The
board shall retain written complaints regarding the plan for
no fewer than three years.
(7) Provide for other matters as may be necessary and
proper for the execution of the board's powers, duties and
obligations under this act.
(i) General powers and authority.--The board shall have the
general powers and authority granted under the laws of this
Commonwealth to health insurers and the specific authority to:
(1) Enter into contracts as are necessary or proper to
carry out the provisions and purposes of this act, including
the authority, with the approval of the commissioner, to
enter into contracts with similar plans of other states for
the joint performance of common administrative functions or
with persons or other organizations for the performance of
administrative functions.
(2) Sue or be sued, including taking legal action
necessary or proper to recover or collect assessments due the
plan.
(3) Take the necessary legal action to:
(i) avoid the payment of improper claims against the
plan or the coverage provided by or through the plan;
(ii) recover any amounts erroneously or improperly
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paid by the plan;
(iii) recover any amounts paid by the plan as a
result of mistake of fact or law; or
(iv) recover other amounts due the plan.
(4) Establish and modify from time to time, as
appropriate, rates, rate schedules, rate adjustments, expense
allowances, producer referral fees, claim reserve formulas
and any other actuarial function appropriate to the operation
of the plan. Rates and premiums charged under this act shall
be consistent with the Patient Protection and Affordable
Health Care Act (Public Law 111-148).
(5) Issue policies of health insurance in accordance
with the requirements of this act.
(6) Appoint appropriate legal, actuarial and other
committees as necessary to provide technical assistance in
the operation of the plan, policy and other contract design,
and any other function within the authority of the plan.
(7) Establish rules, conditions and procedures for
reinsuring risks of participating insurers desiring to issue
plan coverages in their own name. Provision of reinsurance
shall not subject the plan to any of the capital or surplus
requirements, if any, otherwise applicable to reinsurers.
(8) Employ and fix the compensation of employees.
(9) Prepare and distribute certificate of eligibility
forms and enrollment instruction forms to insurance producers
and to the general public.
(10) Provide for reinsurance of risks incurred by the
plan.
(11) Provide for and employ cost containment measures
and requirements, including, but not limited to, preadmission
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screening, second surgical opinion, concurrent utilization
review and individual case management for the purpose of
making the benefit plan more cost effective.
(12) Design, utilize, contract or otherwise arrange for
the delivery of cost-effective health care services,
including establishing or contracting with preferred provider
organizations, health maintenance organizations and other
limited network provider arrangements.
(13) Adopt bylaws, policies and procedures as may be
necessary or convenient for the implementation of this act
and the operation of the plan and meet the necessary
requirements to qualify as a temporary high risk health
insurance plan program under the Patient Protection and
Affordable Health Care Act. The bylaws shall prohibit a
member of the board from voting on or participating in the
selection of a plan administrator or any contract for goods
or services where the board member or an immediate family
member has financial interest in the bidder due to employment
or membership on the governing board of the bidder. The
bylaws shall include a procedure for disclosure of conflicts
of interest.
(j) Annual report.--On or before January 31 of each year,
the board shall make an annual report to the Governor which
shall also be filed with the chairman of the Banking and
Insurance Committee of the Senate and the chairman of the
Insurance Committee of the House of Representatives. The report
shall summarize the activities of the plan in the preceding
calendar year, including the net written and earned premiums,
plan enrollment, the expense of administration and the paid and
incurred losses.
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(k) Liability.--The board and its employees shall not be
liable for the obligations of the plan. No member or employee of
the board shall be liable, and no cause of action of any nature
may arise against them, for an act or omission related to the
performance of their powers and duties under this act unless
such act or omission constitutes willful or wanton misconduct.
The board may provide in its bylaws or rules for indemnification
of and legal representation for its members and employees.
Section 4. Establishment of rules.
The commissioner may, by regulation, establish additional
powers and duties of the board and may adopt such rules as are
necessary and proper to implement this act.
Section 5. Eligibility.
(a) Coverage.--
(1) An individual person shall be eligible for plan
coverage if the individual person:
(i) Is a citizen or national of the United States or
lawfully present in the United States.
(ii) Has been covered under creditable coverage for
the previous six months before applying for coverage.
(iii) Has a preexisting condition at the time of the
application.
(b) Dependents.--Each resident dependent of a person who is
eligible for plan coverage shall also be eligible for plan
coverage.
(c) Ineligibility.--A person shall not be eligible for
coverage under the plan if the person has or obtains health
insurance coverage substantially similar to or more
comprehensive than a plan policy or would be eligible to have
coverage if the person elected to obtain it; except that:
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(1) The person is determined to be eligible for health
care benefits under Title XIX or XXI of the Social Security
Act (49 Stat. 620, 42 U.S.C. § 301 et seq.) except for
benefits authorized under a waiver granted by the Secretary
of Health and Human Services.
(2) The person has previously terminated plan coverage
unless six months have lapsed since such termination. This
paragraph shall not apply with respect to an applicant who is
a federally defined eligible individual.
(3) The person is an inmate or resident of a public
institution. This paragraph shall not apply with respect to
an applicant who is a federally defined eligible individual.
(4) The person's premiums are paid for or reimbursed
under any government-sponsored program or by any government
agency or health care provider, except as an otherwise
qualifying full-time employee or dependent thereof, of a
government agency or health care provider.
(5) The person has had prior coverage with plan
terminated for nonpayment of premium or fraud.
(d) Cessation.--Coverage shall cease upon one of the
following:
(1) On the date a person is no longer a resident of this
Commonwealth.
(2) On the date a person requests coverage to end.
(3) Upon the death of the covered person.
(4) On the date State law requires cancellation of the
policy.
(5) At the option of the plan, 30 days after the plan
makes any inquiry concerning the person's eligibility or
place of residence to which the person does not reply.
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(e) Time frame.--Except as provided under subsection (d), a
person who ceases to meet the eligibility requirements of this
section may be terminated at the end of the policy period for
which the necessary premiums have been paid, counting benefits
provided to the person by another plan toward the person's
lifetime maximum benefits.
Section 6. Unfair referral to plan.
It shall constitute an unfair trade practice for the purposes
of the act of June 22, 1974 (P.L.589, No.205), known as the
Unfair Insurance Practices Act, for an insurer, insurance
producer or third-party administrator to refer an individual
employee to the plan or arrange for an individual employee to
apply to the plan for the purpose of separating that employee
from group health insurance coverage provided in connection with
the employee's employment.
Section 7. Plan administrator.
(a) Selection.--The board shall select a plan administrator
through a competitive bidding process to administer the plan.
The board shall evaluate bids submitted based on criteria
established by the board which shall include:
(1) The plan administrator's proven ability to handle
health insurance coverage to individuals.
(2) The efficiency and timeliness of the plan
administrator's claim processing procedures.
(3) An estimate of total charges for administering the
plan.
(4) The plan administrator's ability to apply effective
cost containment programs and procedures and to administer
the plan in a cost-efficient manner.
(5) The financial condition and stability of the plan
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administrator.
(b) Length of service.--
(1) The plan administrator shall serve for a period
specified in the contract between the plan and the plan
administrator, subject to removal for cause and subject to
any terms, conditions and limitations of the contract between
the plan and the plan administrator.
(2) At least one year prior to the expiration of each
period of service by a plan administrator, the board shall
invite eligible entities, including the current plan
administrator, to submit bids to serve as the plan
administrator. Selection of the plan administrator for the
succeeding period shall be made at least six months prior to
the end of the current period.
(c) Duties.--The plan administrator shall perform such
functions relating to the plan as may be assigned to it,
including:
(1) Determination of eligibility.
(2) Payment of claims.
(3) Establishment of a premium billing procedure for
collection of premiums from persons covered under the plan.
(4) Other necessary functions to assure timely payment
of benefits to covered persons under the plan.
(d) Reports.--The plan administrator shall submit regular
reports to the board regarding the operation of the plan. The
frequency, content and form of the report shall be specified in
the contract between the board and the plan administrator.
(e) Accounting.--Following the close of each calendar year,
the plan administrator shall determine net written and earned
premiums, the expense of administration and the paid and
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incurred losses for the year and report this information to the
board and the department on a form prescribed by the
commissioner.
(f) Compensation.--The plan administrator shall be
compensated as provided in the contract between the plan and the
plan administrator.
Section 8. Funding of plan.
(a) Premiums.--
(1) The plan shall establish premium rates for plan
coverage consistent with the Patient Protection and
Affordable Health Care Act (Public Law 111-148). Premium
rates and schedules shall be submitted to the commissioner
for approval prior to use. If grants and other receipts by
the pool exceed actual losses and expenses of the plan, the
excess shall be held as interest and used by the board to
offset future losses or to reduce premiums.
(2) The plan, with the assistance of the commissioner,
shall determine a standard risk rate by considering the
premium rates charged by other insurers offering health
insurance coverage to individuals. The standard risk rate
shall be established using reasonable actuarial techniques
and shall reflect anticipated experience and expenses for
such coverage. All rates established by the board shall be
consistent with the Patient Protection and Affordable Health
Care Act.
(b) Sources of additional revenue.--The board shall pay plan
costs, first from Federal funds that are transferred under the
Patient Protection and Affordable Health Care Act. The board
shall also make application for any Federal or other grants or
sources under which the plan may be eligible to receive moneys.
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To the extent allowable, the board shall use any moneys received
from grants or other sources to offset plan deficits before
drawing from any alternative funding sources.
(c) Benefits.--
(1) Subject to subsection (b), covered expenses shall be
the usual, customary and reasonable charges in the locality
for the following services and articles when prescribed by a
physician and determined by the plan to be medically
necessary for the following areas of services:
(i) Hospital services.
(ii) Professional services for the diagnosis or
treatment of injuries, illnesses or conditions, other
than mental or dental, which are rendered by a physician
or by other licensed professionals at the physician's or
licensed professional's direction.
(iii) Drugs requiring a physician's prescription.
(iv) Skilled nursing services of a licensed skilled
nursing facility for not more than 120 days during a
policy year.
(v) Services of a home health agency up to a maximum
of 270 services per year.
(vi) Use of radium or other radioactive materials.
(vii) Oxygen.
(viii) Anesthetics.
(ix) Prostheses other than dental.
(x) Rental of durable medical equipment, other than
eyeglasses and hearing aids, for which there is no
personal use in the absence of the conditions for which
it is prescribed.
(xi) Diagnostic X-rays and laboratory tests.
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(xii) Oral surgery for excision of partially or
completely unerupted, impacted teeth or the gums and
tissues of the mouth when not performed in connection
with the extraction or repair of teeth.
(xiii) Services of a physical therapist.
(xiv) Emergency and other medically necessary
transportation provided by a licensed ambulance service
to the nearest facility qualified to treat a covered
condition.
(xv) Outpatient services for diagnosis and treatment
of mental and nervous disorders, provided that a covered
person shall be required to make a 50% copayment and that
the plan's payment shall not exceed $4,000.
(2) Covered expenses shall not include the following:
(i) A charge for treatment for cosmetic purposes
other than surgery for the repair or treatment of an
injury or a congenital bodily defect to restore normal
bodily functions.
(ii) Care which is primarily for custodial or
domiciliary purposes.
(iii) A charge for confinement in a private room to
the extent it is in excess of the institution's charge
for its most common semiprivate room, unless a private
room is medically necessary.
(iv) That part of a charge for services rendered or
articles prescribed by a physician, dentist or other
health care personnel which exceeds the prevailing charge
in the locality or for any charge not medically
necessary.
(v) A charge for services or articles when the
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provision of the services or articles is not within the
scope of authorized practice of the institution or
individual providing the services or articles.
(vi) An expense incurred prior to the effective date
of coverage by the plan for the person on whose behalf
the expense is incurred.
(vii) Dental care except as provided in paragraph
(1)(xii).
(viii) Eyeglasses and hearing aids.
(ix) Illness or injury due to acts of war.
(x) Services of blood donors and any fee for failure
to replace the first three pints of blood provided to an
eligible person each policy year.
(xi) Personal supplies or services provided by a
hospital or nursing home or any other nonmedical or
nonprescribed supply or service.
(xii) Routine maternity charges for a pregnancy,
except where added as optional coverage with payment of
additional premiums.
(xiii) An expense or charge for services, drugs or
supplies that are not provided in accordance with
generally accepted standards of current medical practice.
(xiv) An expense or charge for routine physical
examinations or tests.
(xv) An expense for which a charge is not made in
the absence of insurance or for which there is no legal
obligation on the part of the patient to pay.
(xvi) An expense incurred for benefits provided
under the laws of the United States and this
Commonwealth, including Medicare and Medicaid and other
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medical assistance, military service-connected disability
payments, medical services provided for members of the
armed forces and their dependents or employees of the
Armed Forces of the United States and medical services
financed on behalf of all citizens by the United States.
(xvii) An expense or charge for in vitro
fertilization, artificial insemination or any other
artificial means used to cause pregnancy.
(xviii) An expense or charge for oral contraceptives
used for birth control or any other temporary birth
control measures.
(xix) An expense or charge for sterilization or
sterilization reversals.
(xx) An expense or charge for weight loss programs,
exercise equipment or treatment of obesity, except when
certified by a physician as morbid obesity and at least
two times the normal body weight.
(xxi) An expense or charge for acupuncture treatment
unless used as an anesthetic agent for a covered surgery.
(xxii) An expense or charge for organ or bone marrow
transplants other than those performed at a hospital with
a board-approved organ transplant program that has been
designated by the board as a preferred provider
organization for that specific organ or bone marrow
transplant.
(xxiii) An expense or charge for procedures,
treatments, equipment or services that are provided in
special settings for research purposes or in a controlled
environment, are being studied for safety, efficiency and
effectiveness and are awaiting endorsement by the
20100HB2514PN3743 - 20 -
appropriate national medical specialty college for
general use within the medical community.
(d) Establishment of coverage.--In establishing the plan
coverage, the board shall take into consideration the levels of
health insurance coverage provided in this Commonwealth and
medical economic factors as may be deemed appropriate and
promulgate benefit levels, deductibles, coinsurance factors,
exclusions and limitations determined to be generally reflective
of and commensurate with health insurance coverage provided
through a representative number of large employers in this
Commonwealth.
(e) Rate adjustments.--The board may adjust any deductibles
and coinsurance factors annually not to exceed the Medical
Component of the Consumer Price Index.
(f) Nonduplication of benefits.--
(1) The plan shall be payer of last resort of benefits
whenever any other benefit or source of third-party payment
is available. Benefits otherwise payable under plan coverage
shall be reduced by all amounts paid or payable through any
other health insurance coverage and by all hospital and
medical expense benefits paid or payable under any workers'
compensation coverage, automobile medical payment or
liability insurance whether provided on the basis of fault or
nonfault and by any hospital or medical benefits paid or
payable under or provided pursuant to any Federal or State
law or program.
(2) The plan shall have a cause of action against an
eligible person for the recovery of the amount of benefits
paid that are not for covered expenses. Benefits due from the
plan may be reduced or refused as a set-off against an amount
20100HB2514PN3743 - 21 -
recoverable under this paragraph.
Section 8. Collective action.
Neither the participation in the plan as participating
insurers, the establishment of rates, forms or procedures nor
any other joint or collective action required by this act shall
be the basis of any legal action, criminal or civil liability or
penalty against the plan or any participating insurer.
Section 9. Taxation.
The plan established under this act shall be exempt from any
and all taxes.
Section 19. Expiration.
This act shall expire at the end of the fiscal year in which
the American Health Benefit Exchange under the Patient
Protection and Affordable Health Care Act (Public Law 111-148)
has commenced operation in this Commonwealth and all individuals
covered under this act have had access to the exchange.
Section 20. Effective date.
This act shall take effect in 60 days.
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