HB 690 — An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, in regulation of insurers and related persons generally, providing for group market provisions; and imposing penalties.

PRINTER'S NO.   706

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                            HOUSE BILL
                            No. 690
                                                   Session of
                                                     2025

     INTRODUCED BY ZIMMERMAN, HAMM, PICKETT, GREINER, JAMES,
        OLSOMMER, COOK AND ROAE, FEBRUARY 21, 2025

     REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 21, 2025


                                        AN ACT
 1   Amending Title 40 (Insurance) of the Pennsylvania Consolidated
 2      Statutes, in regulation of insurers and related persons
 3      generally, providing for group market provisions; and
 4      imposing penalties.
 5      The General Assembly of the Commonwealth of Pennsylvania
 6   hereby enacts as follows:
 7      Section 1.     Title 40 of the Pennsylvania Consolidated
 8   Statutes is amended by adding a chapter to read:
 9                                   CHAPTER 41
10                           GROUP MARKET PROVISIONS
11   Subchapter
12      A.     Preliminary Provisions
13      B.     Procedures
14      C.     Miscellaneous Provisions
15                                  SUBCHAPTER A
16                             PRELIMINARY PROVISIONS
17   Sec.
18   4101.   Definitions.
19   § 4101.    Definitions.
 1      The following words and phrases when used in this chapter
 2   shall have the meanings given to them in this section unless the
 3   context clearly indicates otherwise:
 4      "Commissioner."     The Insurance Commissioner of the
 5   Commonwealth.
 6      "Insurer."     An entity licensed by the department with
 7   accident and health authority to issue a policy, subscriber
 8   contract, certificate or plan that provides medical or health
 9   care coverage, including emergency services, and is offered or
10   governed under any of the following:
11             (1)   The act of May 17, 1921 (P.L.682, No.284), known as
12      The Insurance Company Law of 1921, including section 630 and
13      Article XXIV of that act.
14             (2)   The act of December 29, 1972 (P.L.1701, No.364),
15      known as the Health Maintenance Organization Act.
16             (3)   Chapter 61 (relating to hospital plan corporations)
17      or 63 (relating to professional health services plan
18      corporations).
19                                 SUBCHAPTER B
20                                  PROCEDURES
21   Sec.
22   4111.    Furnishing claims experience data to policyholders.
23   § 4111.    Furnishing claims experience data to policyholders.
24      (a)    Requirement.--Subject to the other provisions of this
25   chapter, each insurer shall furnish claims experience data to
26   group policyholders within 30 days of a group policyholder's
27   request unless the information has been furnished to the group
28   policyholder within the preceding six months.
29      (b)    Applicable group size.--Claims experience data shall be
30   furnished for each group of 51 or more covered employees,

20250HB0690PN0706                     - 2 -
 1   members or enrollees, not including dependents.
 2      (c)   Claims experience data defined.--For purposes of this
 3   chapter, claims experience data includes, for at least the last
 4   two policy years, if applicable, separated by policy year, the
 5   aggregated dollar value of each of the following:
 6            (1)   Earned premiums.
 7            (2)   Total incurred claims, including paid, reserved and
 8      incurred but not reserved claims, inclusive of high amount
 9      claims, pooled claims, capitated expenses and noncapitated
10      expenses.
11            (3)   Any amounts incurred in excess of the individual
12      pooling or stop-loss point applicable to the group.
13            (4)   Any amounts under a provider reimbursement
14      methodology other than fee for service that were allocated to
15      the group or otherwise accounted for in rating the group's
16      policy.
17      (d)   Fee permitted.--An insurer may charge a fee for
18   providing the claims experience data to a group policyholder.
19   The fee must be:
20            (1)   Reasonable.
21            (2)   Not unfairly discriminatory.
22            (3)   In accord with a schedule or methodology filed with
23      the department at least 30 days prior to use, which schedule
24      shall become effective unless disapproved by the department
25      prior to use.
26      (e)   Privacy protection.--In providing claims experience data
27   to a group policyholder under this chapter, an insurer shall
28   adhere to all Federal and State laws regarding disclosure of
29   protected health or personal information.
30                                SUBCHAPTER C

20250HB0690PN0706                      - 3 -
 1                           MISCELLANEOUS PROVISIONS
 2   Sec.
 3   4121.    Regulations.
 4   4122.    Enforcement and penalties.
 5   § 4121.    Regulations.
 6      The department may promulgate regulations as necessary and
 7   appropriate to implement, administer and enforce this chapter.
 8   § 4122.    Enforcement and penalties.
 9      (a)    Penalties.--Subject to the other provisions of this
10   section, upon satisfactory evidence of the violation of any
11   section of this chapter by an insurer or any other person, one
12   or more of the following penalties may be imposed at the
13   commissioner's discretion:
14             (1)   Suspension or revocation of the license of the
15      offending insurer or other person.
16             (2)   Refusal, for a period not to exceed one year, to
17      issue a new license to the offending insurer or other person.
18             (3)   A fine of not more than $5,000 for each violation of
19      this chapter.
20             (4)   A fine of not more than $10,000 for each willful
21      violation of this chapter.
22      (b)    Limitations.--
23             (1)   Fines imposed under this section against an insurer
24      may not exceed $500,000 in the aggregate during a single
25      calendar year.
26             (2)   Fines imposed under this section against any other
27      person may not exceed $100,000 in the aggregate during a
28      single calendar year.
29      (c)    Additional remedies.--The enforcement remedies imposed
30   under this section are in addition to other remedies or

20250HB0690PN0706                     - 4 -
 1   penalties that may be imposed under other applicable law of this
 2   Commonwealth, including:
 3            (1)   The act of July 22, 1974 (P.L.589, No.205), known as
 4      the Unfair Insurance Practices Act. Violations of this
 5      chapter shall be deemed to be unfair methods of competition
 6      and unfair or deceptive acts or practices under the Unfair
 7      Insurance Practices Act.
 8            (2)   The act of December 18, 1996 (P.L.1066, No.159),
 9      known as the Accident and Health Filing Reform Act.
10            (3)   The act of June 25, 1997 (P.L.295, No.29), known as
11      the Pennsylvania Health Care Insurance Portability Act.
12      (d)   Administrative procedure.--
13            (1)   The administrative provisions of this section shall
14      be subject to 2 Pa.C.S. Ch. 5 Subch. A (relating to practice
15      and procedure of Commonwealth agencies).
16            (2)   A party against whom penalties are assessed in an
17      administrative action may appeal to Commonwealth Court as
18      provided in 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial
19      review of Commonwealth agency action).
20      Section 2.    This act shall take effect in 60 days.




20250HB0690PN0706                    - 5 -