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
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 quality health care
accountability and protection, further providing for
departmental powers and duties and providing for additional
penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2181(f) of the act of May 17, 1921
(P.L.682, No.284), known as The Insurance Company Law of 1921,
is amended to read:
Section 2181. Departmental Powers and Duties.--* * *
(f) The department shall submit an annual report to the
chairperson and minority chairperson of the Banking and
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Insurance Committee of the Senate and the chairperson and
minority chairperson of the Insurance Committee of the House of
Representatives regarding the implementation, operation and
enforcement of this article, including the aggregate data the
department has compiled under subsection (b). The department
shall post the report on the department's publicly accessible
Internet website.
Section 2. The act is amended by adding a section to read:
Section 2182.1. Additional Penalties.--(a) The department
shall order an insurer to pay penalties in accordance with
subsection (b) whenever the aggregated data compiled under
section 2181(b) shows that more than fifty per centum (50%) of
all adverse benefit determinations, excluding administrative
denials, issued by the insurer in a calendar year were
overturned through the insurer's internal claim and appeal
procedures specified in section 2164 or the external review
processes specified in section 2164.5, 2164.6 or 2164.7.
(b) The department shall order an insurer to pay a penalty
for each overturned adverse benefit determination in excess of
the threshold specified in subsection (a) as follows:
(1) For the first overturned adverse benefit determination,
fifty thousand dollars ($50,000).
(2) For the second overturned adverse benefit determination,
one hundred thousand dollars ($100,000).
(3) For the third and each subsequent overturned adverse
benefit determination, two hundred fifty thousand dollars
($250,000).
(c) Penalties collected by the department under this section
shall be used by the department for consumer protection
activities.
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(d) The penalties under this section shall be in addition to
any other penalty or remedy imposed under any other applicable
statute.
Section 3. This act shall take effect in six months.
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