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. 1272
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1152
Session of
2025
INTRODUCED BY COOPER, ABNEY, BANTA, BENHAM, BERNSTINE, BOROWSKI,
BOYD, M. BROWN, CAUSER, DAVANZO, DEASY, FLICK, FLOOD,
FRANKEL, FRITZ, GREEN, GUENST, JAMES, KULIK, KUZMA, MAJOR,
McANDREW, O'MARA, OLSOMMER, PIELLI, PROBST, PUGH, RADER,
REICHARD, SMITH, STEELE, VENKAT AND D. WILLIAMS,
APRIL 4, 2025
REFERRED TO COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY
PREPAREDNESS, APRIL 4, 2025
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, further
providing for billing.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 635.7(b), (d), (e) and (g) of the act of
May 17, 1921 (P.L.682, No.284), known as The Insurance Company
Law of 1921, are amended and the section is amended by adding
subsections to read:
Section 635.7. Billing.--* * *
[(b) An insurer must reimburse a nonnetwork EMS agency under
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the following:
(1) The EMS agency has submitted a completed standardized
form to the department requesting nonnetwork direct
reimbursement from an insurer an EMS agency has identified. The
form must be submitted to the department annually by October 15.
The form shall declare the EMS agency's intention to receive
direct payment from an insurer identified on the form for the
next calendar year. The department shall develop a standardized
form, using an EMS agency's assigned license number, to be used
by an EMS agency that meets the conditions established under
this section. The department shall develop and maintain a
publicly accessible electronic registry that indicates which EMS
agency has requested nonnetwork direct reimbursement from an
insurer identified on the form.
(2) An EMS agency has provided notification to the insurer
upon submitting a claim for reimbursement that the EMS agency is
registered with the department to receive direct reimbursement
as provided for under this section.]
(b.1) An EMS agency may seek reimbursement and shall accept
payment from an insurer for services that have been provided to
a covered person for dispatched 911 emergency medical services.
(b.2) Upon receiving a bill for dispatched 911 emergency
medical services, an insurer shall directly reimburse a
designated EMS agency within forty-five days at three hundred
fifty percent of the current published rate for ambulance
services as established by the Centers for Medicare and Medicaid
Services under 42 U.S.C. Ch. 7 Subch. XVIII (relating to health
insurance for aged and disabled) for the same service provided
in the same geographic area and according to:
(1) The allowable amount afforded under this section only
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applies to dispatched 911 emergency medical services and does
not apply to any other covered service provided by a
participating network provider under a health insurance policy.
(2) Payment made by the insurer in compliance with this
section shall be considered payment in full for the service
provided, except for any copayment, coinsurance, deductible or
other cost-sharing amounts required to be paid by the covered
person.
(3) An EMS agency may not bill the covered person directly
or indirectly or otherwise attempt to collect from a covered
person, except to recover a cost-sharing amount.
(4) An insurer may not require an EMS agency to contract
with the insurer to receive reimbursement under this section.
* * *
[(d) Where an insurer has reimbursed a nonnetwork EMS agency
at the same rate it has established for a network EMS agency,
the EMS agency may not bill the insured directly or indirectly
or otherwise attempt to collect from the insured for the service
provided, except for a billing to recover a copayment,
coinsurance or deductible as specified in the health insurance
policy.]
(e) An EMS agency [that submits a form under this section]
may solicit donations or memberships or conduct fundraising,
except that an EMS agency may not promise, suggest or infer to
donors that a donation will result in the donor not being billed
directly for any payment as provided under this section.
Notwithstanding this paragraph, an EMS agency may bill in
accordance with subsection [(d)] (b.2)(3). A violation of this
section shall be considered a violation of the act of December
17, 1968 (P.L.1224, No.387), known as the "Unfair Trade
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Practices and Consumer Protection Law."
* * *
[(g) This section shall apply only to an EMS agency that is
a nonnetwork provider and provides emergency medical services,
unless preempted by Federal law.]
* * *
Section 2. This act shall take effect in 60 days.
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