HB 392 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, further providing for billing.

PRINTER'S NO.   357

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 392
                                               Session of
                                                 2025

     INTRODUCED BY GROVE, STENDER, KUTZ, STAATS AND GILLEN,
        JANUARY 28, 2025

     REFERRED TO COMMITTEE ON INSURANCE, JANUARY 28, 2025


                                    AN ACT
 1   Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
 2      act relating to insurance; amending, revising, and
 3      consolidating the law providing for the incorporation of
 4      insurance companies, and the regulation, supervision, and
 5      protection of home and foreign insurance companies, Lloyds
 6      associations, reciprocal and inter-insurance exchanges, and
 7      fire insurance rating bureaus, and the regulation and
 8      supervision of insurance carried by such companies,
 9      associations, and exchanges, including insurance carried by
10      the State Workmen's Insurance Fund; providing penalties; and
11      repealing existing laws," in casualty insurance, further
12      providing for billing.
13      The General Assembly of the Commonwealth of Pennsylvania
14   hereby enacts as follows:
15      Section 1.    Section 635.7 of the act of May 17, 1921
16   (P.L.682, No.284), known as The Insurance Company Law of 1921,
17   is amended by adding subsections to read:
18      Section 635.7.    Billing.--* * *
19      (b.1)   When an insurer reimburses for a nonnetwork EMS agency
20   emergency medical service and the reimbursement payment is paid
21   directly to an insurance policyholder, the payment shall be
22   accompanied with a notification in writing that includes the
23   following information:
 1      (1)   the date the emergency medical service was performed;
 2      (2)   the name of the EMS agency that performed the emergency
 3   medical service;
 4      (3)   an itemized explanation of the claim amount and
 5   reimbursement amount issued by the insurer;
 6      (4)   the EMS agency billing address that filed the claim for
 7   the emergency medical service performed; and
 8      (5)   a disclosure that states:
 9      This reimbursement payment is issued to the policyholder
10   (insert NAME), for a claim filed for nonnetwork emergency
11   medical services on (insert DATE of emergency service). The
12   reimbursement funds enclosed are to be used for the sole purpose
13   of payment of a liability for emergency medical services
14   outlined in this notification. The use of these funds for any
15   other purpose other than to satisfy the emergency medical
16   services liability may result in an insurance fraud claim
17   against the policyholder or individual that received the
18   emergency medical service on (insert DATE).
19      (b.2)   An insurer that reimburses for a nonnetwork EMS agency
20   emergency medical service shall notify the EMS agency monthly
21   that a claim payment has been issued by the insurer to the
22   policyholder for the billing of a medically necessary emergency
23   medical service.
24      * * *
25      Section 2.   This act shall take effect in 60 days.




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