HB 966 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for departmental powers and duties and providing for additional penalties.

PRINTER'S NO.   1043

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 966
                                               Session of
                                                 2025

     INTRODUCED BY VENKAT, FRIEL, KOSIEROWSKI, MEHAFFIE, KHAN,
        WEBSTER, PIELLI, HARKINS, MADDEN, GIRAL, McNEILL, STEELE,
        FRANKEL, INGLIS, MAYES, SALISBURY, BENHAM, PROBST, HILL-
        EVANS, CERRATO, BOROWSKI, SANCHEZ, CARROLL, FREEMAN, RIVERA,
        BRENNAN, RABB, HADDOCK, GUENST, HOWARD, KENYATTA AND
        HANBIDGE, MARCH 19, 2025

     REFERRED TO COMMITTEE ON INSURANCE, MARCH 19, 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 quality health care
12      accountability and protection, further providing for
13      departmental powers and duties and providing for additional
14      penalties.
15      The General Assembly of the Commonwealth of Pennsylvania
16   hereby enacts as follows:
17      Section 1.    Section 2181(f) of the act of May 17, 1921
18   (P.L.682, No.284), known as The Insurance Company Law of 1921,
19   is amended to read:
20      Section 2181.    Departmental Powers and Duties.--* * *
21      (f)   The department shall submit an annual report to the
22   chairperson and minority chairperson of the Banking and
 1   Insurance Committee of the Senate and the chairperson and
 2   minority chairperson of the Insurance Committee of the House of
 3   Representatives regarding the implementation, operation and
 4   enforcement of this article, including the aggregate data the
 5   department has compiled under subsection (b). The department
 6   shall post the report on the department's publicly accessible
 7   Internet website.
 8      Section 2.   The act is amended by adding a section to read:
 9      Section 2182.1.   Additional Penalties.--(a)   The department
10   shall order an insurer to pay penalties in accordance with
11   subsection (b) whenever the aggregated data compiled under
12   section 2181(b) shows that more than fifty per centum (50%) of
13   all adverse benefit determinations, excluding administrative
14   denials, issued by the insurer in a calendar year were
15   overturned through the insurer's internal claim and appeal
16   procedures specified in section 2164 or the external review
17   processes specified in section 2164.5, 2164.6 or 2164.7.
18      (b)   The department shall order an insurer to pay a penalty
19   for each overturned adverse benefit determination in excess of
20   the threshold specified in subsection (a) as follows:
21      (1)   For the first overturned adverse benefit determination,
22   fifty thousand dollars ($50,000).
23      (2)   For the second overturned adverse benefit determination,
24   one hundred thousand dollars ($100,000).
25      (3)   For the third and each subsequent overturned adverse
26   benefit determination, two hundred fifty thousand dollars
27   ($250,000).
28      (c)   Penalties collected by the department under this section
29   shall be used by the department for consumer protection
30   activities.

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1      (d)     The penalties under this section shall be in addition to
2   any other penalty or remedy imposed under any other applicable
3   statute.
4      Section 3.    This act shall take effect in six months.




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