Patient Protection and Affordable Care Act—Guidance for Compliance Filings; Notice No. 2010-07
[40 Pa.B. 3754]
[Saturday, July 3, 2010]
The Patient Protection and Affordable Care Act was enacted by the United States Congress and signed into law by the President on March 23, 2010, and the Health Care and Education Reconciliation Act was enacted by the United States Congress and signed into law by the President on March 30, 2010 (hereinafter collectively referred to as the PPACA). The PPACA sets forth immediate market reform requirements (for plan years beginning on or after September 23, 2010) for health insurance product forms for individual, small group, and large group health benefit plans that provide ''major medical'' coverage, which is comprehensive health coverage, including PPO and HMO coverage.
The Insurance Department (Department) provides the following guidance to insurance entities seeking to demonstrate compliance with the PPACA relative to policies offered, issued or renewed in this Commonwealth. This guidance is limited to policy forms for which an insurance entity (insurer) is not seeking to make any changes other than as necessary to make the policy form comply with the PPACA.
If an insurer is ordinarily required by the Accident and Health Filing Reform Act (act) (40 P. S. §§ 3801—3815) to file one or more policy forms with the Department for prior approval, and the insurer is not seeking to make any changes other than as necessary to make those policy forms comply with the PPACA, the Commonwealth will accept as evidence of satisfying the PPACA immediate market reform requirements a ''Certification'' executed by an authorized representative of the insurer substantially identical to the ''Certification'' form as follows as Attachment A. Attachment A is also available on the Department's web site at www.insurance.pa.gov. File a ''Certification'' upon completion of all necessary modifications to the applicable policy forms.
Copies of the policy forms themselves are not required to be filed.
To accommodate the immediate nature of the PPACA's market reform requirements, the policy form filings for which the ''Certification'' is submitted will be exempt from the prior approval filing requirements of the act. Upon submission of a ''Certification'' as previously set forth, the policy forms will be presumed to comply with the immediate PPACA market reform requirements and may be used. Submit the ''Certification'' on or before September 10, 2010.
Subsequent policy form filings, or policy form filings containing changes beyond those required by the immediate PPACA provisions, must comply with the filing requirements of the act.
The Commonwealth does not require that the NAIC PPACA Uniform Compliance Summary form be filed for any policy form. However, insofar as it may provide guidance to the industry for purposes of assuring compliance with the PPACA, the form may be accessed on the System for Electronic Rate and Form Filing (SERFF) or on the Department's web site at www.insurance.pa.gov.
Finally, although the forms subject to this notice will not be reviewed and approved by the Department, those forms (and all forms used in this Commonwealth) remain subject to, and must comply in all respects with, the Commonwealth's insurance laws and regulations, and the Department retains its ability to take enforcement actions and seek any available remedy for noncompliant forms. An insurer will be responsible for assuring that all of its insureds are provided the full benefits provided by the PPACA.
Questions regarding this notice may be directed to Peter Camacci, Director of the Bureau of Accident and Health, Insurance Department, 1311 Strawberry Square, Harrisburg, PA 17120, (717) 787-9100, Pcamacci@state.pa.us.
JOEL SCOTT ARIO,
PENNSYLVANIA ISSUER CERTIFICATION FORM
(relating to immediate market reform requirements of the Patient Protection and
Affordable Care Act (PPACA))
Name of Insurer:
I hereby certify that each policy form required to be brought into compliance with the requirements of the Patient Protection and Affordable Care Act, P. L. 111-148, 124 Stat. 119, and the Health Care and Education Reconciliation Act of 2010, P. L. 111-152, 124 Stat. 1051 (hereinafter collectively referred to as the ''PPACA'') has been modified to bring it into compliance therewith. The PPACA sets forth immediate market reform requirements (for plan years beginning on or after September 23, 2010) for health insurance product forms for individual, small group, and large group health benefit plans that provide ''major medical'' coverage, which is comprehensive health coverage, including PPO and HMO coverage.
The information set forth in this Certification, to the best of my knowledge, information and belief, is true, correct, and complete.
Name of Authorized Representative of the Insurer
Signature of Authorized Representative of the Insurer
[Pa.B. Doc. No. 10-1231. Filed for public inspection July 2, 2010, 9:00 a.m.]
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