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§ 1415. Health insurance premium payment program

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 62 P.S. Poor Persons and Public WelfareEffective: July 7, 2005

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 62 P.S. Poor Persons and Public Welfare (Refs & Annos)
Chapter 1. Human Services Code (Refs & Annos)
Article XIV. Fraud and Abuse Control (Refs & Annos)
Effective: July 7, 2005
62 P.S. § 1415
§ 1415. Health insurance premium payment program
(a) The department is authorized to purchase employe group health care coverage on behalf of any medical assistance recipient whenever it is cost effective to do so.
(b) Upon request of the department, every insurer shall provide the department with benefit information needed to determine the eligibility of a medical assistance recipient for employe group health care coverage.
(c) Every insurer shall honor a request for enrollment and purchase of employe group health insurance submitted by the department with respect to a medical assistance recipient with consideration for enrollment season restrictions, but no enrollment restrictions shall delay enrollment more than ninety days from the date of the department's request. Once enrolled, the insurer shall honor a request for disenrollment submitted by the department, without imposing personal liability upon the medical assistance recipient, whenever it is no longer cost effective for the department to pay the premiums or when the recipient is no longer eligible for medical assistance.
(d) The department may administratively impose a civil penalty of up to one thousand dollars ($1,000) per violation against any insurer who fails to comply with the requirements of this section.
(e) This section shall apply to all such policies, contracts, certificates or programs issued, renewed, modified, altered, amended or reissued on or after the effective date of this section.
(f) As used in this section, the following words and phrases shall have the following meanings:
(1) The term “insurer” includes:
(i) A stock insurance company incorporated for any of the purposes set forth in section 202(c) of the act of May 17, 1921 (P.L. 682, No. 284),1 known as “The Insurance Company Law of 1921.”
(ii) A mutual insurance company incorporated for any of the purposes set forth in section 202(d) of “The Insurance Company Law of 1921.”
(iii) A professional health services plan corporation as defined in 40 Pa.C.S. Ch. 63 (relating to professional health services plan corporations).
(iv) A hospital plan corporation as defined in 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations).
(v) A fraternal benefit society as defined in 40 Pa.C.S. Ch. 63.2
(vi) A health maintenance organization as defined in the “Health Maintenance Organization Act.”
(vii) Any other person who sells or issues contracts or certificates of insurance.
(viii) A person, including an employer or third-party administrator, providing or administering employee group health care coverage, to the maximum extent permitted by Federal law.
(2) The phrase “employe group health care coverage” means health care coverage that the department is authorized to purchase for medical assistance recipients in section 1906 of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396e).

Credits

1967, June 13, P.L. 31, art. 14, § 1415, added 2005, July 7, P.L. 177, No. 42, § 9, imd. effective.

Footnotes

40 P.S. § 382.
Should have read “40 Pa.C.S. Ch. 65” (repealed); see now, 40 P.S. § 991.2401 et seq.
62 P.S. § 1415, PA ST 62 P.S. § 1415
Current through 2022 Regular Session Act 20. Some statute sections may be more current, see credits for details.
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