NOTICES
Repeal of Outdated Notices Regarding Form and Rate Filings; Filing Requirements under the Accident and Health Filing Reform Act; Notice 2016-01
[46 Pa.B. 535]
[Saturday, January 23, 2016]Certain accident and health insurance policy forms, subject to filing under section 3(a) of the Accident and Health Filing Reform Act (40 P. S. § 3801.303(a)), added by the act of December 18, 1996 (P. L. 1066, No. 159) (Act 159), were exempted from filing with the Insurance Department (Department) by the Insurance Commissioner (Commissioner) by notices published at 26 Pa.B. 1453 (March 30, 1996) and 32 Pa.B. 3449 (July 13, 2002)1 under the authority of section 3(b) of Act 159. In addition, there may be notices issued prior to Act 159 regarding form and rate filings that some may view as still in effect, including Notice 1992-17, ''Notice of the Insurance Commissioner Pursuant to Section 354 of The Insurance Company Law of 1921, Act of May 17, 1921, P. L. 682 (40 P. S. § 477(b)) Revising Requirements for Filing Certain Accident and Health Forms.''
The Federal Patient Protection and Affordable Care Act (Pub. L. No. 111-148) and the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152) (together, the Affordable Care Act (ACA)) and regulations and other Federal guidance promulgated thereunder have imposed new requirements on accident and health policy forms and rates in the large and small group markets, as well as the individual market. Act 159 was amended by the act of December 22, 2011 (P. L. 614, No. 134) (Act 134) to assure that the Commonwealth would maintain its authority to review rates for accident and health policies in light of the ACA.
In recognition of the recent changes in health insurance requirements, and to monitor and assure compliance with the ACA and state law requirements, the Department has determined that it is in the public interest to review forms, including riders, amendments and endorsements, for all group accident and health policies (other than disability) as well as all individual policies. First, all group accident and health forms, for both large and small groups, are required to comply with provisions of state and Federal law, including requirements brought about by the ACA and Federal laws that have explicit correlation to state law requirements, such as the mental health parity and genetic nondiscrimination requirements. (See the Health Insurance Coverage Parity and Nondiscrimination Act (40 P. S. §§ 908-11—908-16).) It will assist the Department in protecting insurance consumers in this Commonwealth to receive these forms prior to use as specified in Act 134.2 Second, the Department has determined that its review of small group rate filings should be informed by a coordinated review of the forms associated with those rate filings. In addition, under Act 134, and consistent with the ACA, student, blanket, and franchise accident and health insurance is now defined and recognized, not as group, but as individual coverage. To maintain the Commonwealth's status under the ACA as an effective rate review state and to assure that consumers in this Commonwealth receive all protections and benefits required by law, the Department will review student, blanket, and franchise accident and health policy rates.3 As with small group products, a review of the forms for student and franchise policies will inform its review of those rates; however, due to the particular nature of blanket insurance, the Department intends to continue exempting blanket insurance from form filing.
Form Filings
Section 3(b) of Act 159 authorizes the Commissioner to require forms exempted from filing to be subsequently made subject to filing with the Department upon 90 days advance notice published in the Pennsylvania Bulletin. By this publication, the Commissioner hereby communicates her intent to discontinue certain form filing exemptions and reinstitute certain form filings.4 Accordingly, the Department identifies the forms that are currently required to be filed, as well as those that will no longer be exempt from filing, effective for the plan years specified. The forms specified here are required to be filed by each insurer, as that term is defined in Act 159, provided, however, that a form eligible to be filed through, and in fact filed through, the Interstate Insurance Compact need not be filed with the Department in accordance with this notice.
Forms currently required to be filed
• Individual accident and health forms, including:
o Individual major medical forms (other than student, franchise, and blanket policies, as elsewhere specified in this notice).
o Individual disability forms.
o Individual limited benefit forms.5
o Individual long-term care forms.
o Individual Medicare supplement forms.
• Group long-term care and Medicare supplement forms.
Forms to be filed for plan years beginning on or after July 1, 2016
• Student and franchise accident and health forms.
Forms to be filed for plan years beginning on or after January 1, 2017
• Major medical accident and health forms sold to small groups.
• Limited benefit forms sold to small groups.
Forms to be filed for plan years beginning on or after January 1, 2018
• Major medical accident and health forms sold only to large groups.
Forms continuing to be deregulated and not subject to filing
• Blanket accident and health forms.
• Group disability forms.
• Limited benefit forms sold only to large groups.
Notwithstanding the continued exemption of certain forms from filing, the Department reminds insurers that it retains full authority to request a copy of any form being issued in this Commonwealth, as provided in section 10 of Act 159 (40 P. S. § 3801.310).
Rate Filings
The Department by this notice reminds insurers that the following accident and health rates are currently required to be filed:
• All individual major medical, student, franchise, blanket, limited benefit, long-term care and Medicare supplement rates.
• All major medical and limited benefit rates for policies sold to small groups.
• All group long-term care and Medicare supplement rates.
The current form and rate filing requirements identified in this notice shall remain in effect as stated; the form filing requirements not currently in effect shall take effect for the plan years stated; and the discontinuation of the form filing exemptions specified by this notice shall be effective 90 days after publication of this notice in the Pennsylvania Bulletin. In accordance with section 3(a) of Act 159, as amended by Act 134, forms shall be filed no less than 45 days prior to use.
Questions concerning this notice may be directed to the Bureau of Life, Accident and Health, Office of Insurance Product Regulation, 1326 Strawberry Square, Harrisburg, PA 17120, ra-rateform@pa.gov.
TERESA D. MILLER,
Insurance Commissioner
[Pa.B. Doc. No. 16-137. Filed for public inspection January 22, 2016, 9:00 a.m.] _______
1 The notice published at 32 Pa.B. 3449 repealed the notice published at 28 Pa.B. 4302 (August 29, 1998), under which the deregulation notices published at 27 Pa.B. 1893 (April 12, 1997) and 27 Pa.B. 3118 (June 28, 1997) had been temporarily discontinued.
2 The Department notes that once it is assured that the insurance industry is familiar with post-ACA requirements, it may repeal this review of large group forms. See, for example, 28 Pa.B. 4302 (requiring form filings to assure compliance with the act of June 17, 1998 (P. L. 464, No. 68)), later repealed by Notice 2002-06 published at 32 Pa.B. 3449.
3 Blanket insurance is individual insurance under Act 134. However, because of its particular nature, rather than requiring blanket insurance rates to be filed 45 days prior to use, the Department by this notice is establishing a shorter period of 15 days for these rate filings. See section 3(c) of Act 159.
4 Insofar as any exemption notice issued prior to the effective date of Act 159 is believed to still be extant, any exemption thereunder, like the notices specifically identified herein, is discontinued by this notice.
5 Limited benefit policies, for purposes of this notice, include dental, vision, hospital and other fixed indemnity, accident-only, critical illness, specified disease, wraparound, short-term limited duration health and any other supplemental or excepted benefit accident and health insurance policies.
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
