STATEMENTS OF POLICYSTATEMENTS OF POLICY
Title 31--INSURANCE
INSURANCE DEPARTMENT
[31 PA. CODE CH. 90b]
Medicare Supplement Excess Benefit Policies
[27 Pa.B. 3235] The Insurance Department (Department) deletes Chapter 90b (relating to health care practitioners medicare fee control--statement of policy) to read as set forth in Annex A. Since the chapter was issued as a statement of policy and not as regulations, it is not necessary to publish the deletion in proposed form. The statement of policy was announced under the authority of sections 206, 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S. §§ 66, 186, 411 and 412) and section 354 of The Insurance Company Law of 1921 (40 P. S. § 477b). The statement of policy provided guidelines for the implementation of section 31 of the Health Care Practitioners Medicare Fee Control Act (act) (35 P. S. § 449.31) which was signed into law on July 10, 1990.
Purpose
The purpose of this notice is to delete Chapter 90b to eliminate an obsolete statement of policy that no longer serves any compelling public interest. The statement of policy was issued on September 7, 1990, as a result of the passage of the act (35 P. S. §§ 449.31--449.36), which was signed into law on July 10, 1990. The act prohibits health care practitioners, primary health facilities and other entities from balance billing patients covered by the Medicare Program. ''Balance billing'' is defined as charging or collecting from a Medicare patient an amount in excess of the reasonable charge determined by the United States Secretary of Health and Human Services.
Section 90b.1 (relating to Department rate and form approval) advises that the Department would no longer approve rate and form filings for Medicare Supplement policies and certificates that provided benefits in excess of 20% of the approved Medicare reasonable charge. Because the transition period for filing rates and forms under the act is well expired, this section of the statement of policy is unnecessary and does not serve any compelling public interest.
In addition, the Department no longer approves Medicare Supplement policies and certificates under section 354 of The Insurance Company Law of 1921. Section 354 relating to the approval of accident and health forms was repealed insofar as it is inconsistent under The Accident and Health Filing Reform Act (relating to current policyholders and certificateholders; and submission of rate and form filings to conform to the Health Care Practitioners Medicare Fee Control Act (1990-81)), signed into law on December 18, 1996. Accordingly, Chapter 90b has been superseded by a change in the law.
Sections 90b.2 and 90b.3 list transition requirements relating to changes in policy forms and rates. These sections required insurers to allow then current policyholders the opportunity to eliminate excess benefit coverage during the policy term or at the next renewal. The statement of policy further required that insurers and health maintenance organizations make rate and form filings to conform with the act. Reviews under §§ 90b.2 and 90b.3 have not been applicable since 1991, the first year of implementation of the statement of policy. Sections 90b.2 and 90b.3 were transitional guidelines and are not applicable to any new Medicare Supplement policies being issued in this Commonwealth. Therefore this guidance is obsolete and unnecessary.
Comments regarding the deletion of this statement of policy were solicited from the various trade associations representing the insurance industry, and other Commonwealth agencies. No comments were received.
Fiscal Impact
There will be no fiscal impact as a result of the deletion of this statement of policy.
Paperwork
There will be no impact on paperwork as a result of the deletion of this statement of policy.
Affected Parties
The deletion of these sections will affect all insurers who are licensed to sell Medicare supplement policies and certificates in this Commonwealth.
Effectiveness/Sunset Date
The deletion of the statement of policy will become effective upon publication in the Pennsylvania Bulletin. Because the document proposes to delete an obsolete statement of policy, no sunset date has been assigned.
Contact Person
Information regarding this matter may be addressed in writing to Geoffrey Dunaway, Director, Accident and Health Bureau, 1311 Strawberry Square, Harrisburg, PA 17120, (717) 787-0684.
GREGORY S. MARTINO,
Acting Insurance Commissioner(Editor's Note: The regulations of the Department are amended by deleting a statement of policy in §§ 90b.1--90b.3 to read as set forth in Annex A.)
Fiscal Note: 11-161. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 31. INSURANCE
PART IV. LIFE INSURANCE
CHAPTER 90b. (Reserved) §§ 90b.1--90b.3. (Reserved).
[Pa.B. Doc. No. 97-1082. Filed for public inspection July 3, 1997, 9:00 a.m.]
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