reglab/statecodes huggingface dataset:
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7126 - Requirements of principle-based valuation

§ 7126. Requirements of principle-based valuation.
(a) Characteristics of valuation.--
For policies or contracts specified in the valuation manual, a company shall establish reserves using a principle-based valuation that:
(1) Quantifies benefits and guarantees and the funding associated with contracts and their risks at a level of conservatism that reflects conditions that include unfavorable events having a reasonable probability of occurring during the lifetime of the contracts. For policies or contracts with significant tail risk, the valuation must reflect conditions appropriately adverse to quantify the tail risk.
(2) Incorporates assumptions, risk analysis methods and financial models and management techniques that are consistent with, but not necessarily identical to, those utilized within the company's overall risk assessment process, while recognizing potential differences in financial reporting structures and any prescribed assumptions or methods.
(3) Incorporates assumptions that are:
(i) Prescribed in the valuation manual.
(ii) If not prescribed in the valuation manual, established by utilizing either of the following:
(A) The company's available experience, to the extent it is relevant and statistically credible.
(B) Other relevant and statistically credible experience, to the extent that company data is not available, relevant or statistically credible.
(4) Provides margins for uncertainty, including adverse deviation and estimation error, so that the greater the uncertainty, the larger the margin and resulting reserve.
(b) Company requirements.--
A company using a principle-based valuation for one or more policies or contracts subject to this section as specified in the valuation manual shall:
(1) Establish procedures for corporate governance and oversight of the actuarial valuation function consistent with those described in the valuation manual.
(2) Provide to the commissioner and the board of directors an annual certification of the effectiveness of the internal controls with respect to the principle-based valuation. These controls shall be designed to assure that all material risks inherent in the liabilities and associated assets subject to this valuation are included in the valuation and that valuations are made in accordance with the valuation manual. The certification shall be based on the controls in place as of the end of the preceding calendar year.
(3) Develop and file with the commissioner upon request a principle-based valuation report that complies with standards prescribed in the valuation manual.
(c) Formulaic reserve component.--
A principle-based valuation may include a prescribed formulaic reserve component.
Cross References.
Section 7126 is referred to in sections 7102, 7103, 7112, 7125, 7131, 7137, 7141 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7127 - Experience reporting for policies in force on or after operative date of valuation manual

§ 7127. Experience reporting for policies in force on or after operative date of valuation manual.
A company shall submit to the commissioner, or the commissioner's designee or agent, mortality, morbidity, policyholder behavior or expense experience and other data as prescribed in the valuation manual.
Cross References.
Section 7127 is referred to in sections 7102, 7125 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7131 - Confidential information defined

§ 7131. Confidential information defined.
As used in this subchapter, the following words and phrases shall have the meanings given to them in this section unless the context clearly indicates otherwise:
"Confidential information." Any of the following:
(1) A memorandum in support of an opinion submitted under section 7113 (relating to actuarial opinion of reserves prior to operative date of valuation manual) or 7114 (relating to actuarial opinion of reserves on or after operative date of valuation manual) and any other documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with the memorandum.
(2) All documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in the course of an examination made under section 7125(d) (relating to valuation manual for policies issued on or after operative date of valuation manual), except that confidential information shall not include an examination report or other material prepared in connection with an examination made under Article IX of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of 1921, to the extent not held to be private and confidential information under section 905 of The Insurance Department Act of 1921.
(3) Reports, documents, materials and other information developed by a company in support of or in connection with an annual certification by the company under section 7126(b)(2) (relating to requirements of principle-based valuation), which evaluates the effectiveness of the company's internal controls regarding a principle-based valuation, and any other documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with the reports, documents, materials and other information.
(4) A principle-based valuation report developed under section 7126(b)(3) and any other documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with the report.
(5) Experience data, experience materials and any other documents, materials, data and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with experience data or experience materials.
Cross References.
Section 7131 is referred to in section 7137 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7132 - General rule for confidential information

§ 7132. General rule for confidential information.
Except as otherwise provided in this subchapter, confidential information shall be privileged and given confidential treatment and shall not be:
(1) Subject to discovery or admissible as evidence in a private civil action.
(2) Subject to subpoena.
(3) Subject to the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law.
Cross References.
Section 7132 is referred to in section 7137 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7133 - Private civil actions

§ 7133. Private civil actions.
The commissioner, department or any person who receives documents, materials or other information while acting under the authority of the commissioner or department or with whom the documents, materials or other information are shared under this chapter may not be permitted or required to testify in any private civil action concerning any confidential information covered under this subchapter.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7134 - Use of confidential information by department

§ 7134. Use of confidential information by department.
To assist in the performance of its duties, the department may:
(1) Use confidential information in the furtherance of any regulatory or legal action brought against a company as a part of the department's official duties.
(2) Share confidential information with regulatory or law enforcement officials of this Commonwealth or other jurisdictions, IAIS, NAIC and its affiliates and subsidiaries, group-wide supervisors and members of a supervisory college under section 1406.1 of The Insurance Company Law of 1921, if prior to receiving the confidential information the recipient agrees, and has the legal authority to agree, to maintain the confidential and privileged status of the confidential information in the same manner and to the same extent as required for the commissioner.
(3) Receive, and shall maintain as confidential, any confidential information from the Actuarial Board for Counseling and Discipline or its successor, from NAIC and its affiliates and subsidiaries and from regulatory and law enforcement officials of this Commonwealth or other jurisdictions with the understanding that the documents, materials or other information received are confidential by law in those jurisdictions and shall be given the same confidential treatment provided by this subchapter.
Cross References.
Section 7134 is referred to in section 7136 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7136 - No waiver of privilege or confidentiality

§ 7136. No waiver of privilege or confidentiality.
(a) Sharing of information by department.--
The sharing of confidential information with or by the department as authorized by section 7134 (relating to use of confidential information by department) shall not constitute a waiver of any applicable privilege or claim of confidentiality in the documents, materials or information.
(b) Privilege established in other jurisdictions.--
A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under this subchapter shall be available and enforced in any proceeding in, and in any court of, this Commonwealth.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7137 - Limited exceptions

§ 7137. Limited exceptions.
Notwithstanding section 7132 (relating to general rule for confidential information), confidential information as defined in section 7131(1) and (4) (relating to confidential information defined):
(1) May be shared with the Actuarial Board for Counseling and Discipline if the information is required for the purpose of professional disciplinary proceedings and the Actuarial Board for Counseling and Discipline recipient agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of the documents, materials, data and other information in the same manner and to the same extent as required for the commissioner.
(2) May be subject to subpoena for the purpose of defending an action seeking damages from the actuary submitting the related memorandum in support of an opinion submitted under section 7113 (relating to actuarial opinion of reserves prior to operative date of valuation manual) or 7114 (relating to actuarial opinion of reserves on or after operative date of valuation manual) or a principle-based valuation report developed under section 7126(b)(3) (relating to requirements of principle-based valuation) by reason of an action required by this chapter or regulations promulgated under this chapter.
(3) May be released by the commissioner with the written consent of the company.
(4) Is no longer confidential once any portion of a memorandum in support of an opinion submitted under section 7113 or 7114 or a principle-based valuation report developed under section 7126(b)(3) is:
(i) cited by the company in its marketing materials;
(ii) publicly released to a governmental agency other than a State insurance department; or
(iii) released by the company to the news media.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7141 - Single-state company exemption

§ 7141. Single-state company exemption.
(a) Requirements.--
A company may file a written request with the commissioner to exempt specific product forms or product lines issued by a domestic company from the requirements of sections 7125 (relating to valuation manual for policies issued on or after operative date of valuation manual) and 7126 (relating to requirements of principle-based valuation) if the company:
(1) Is licensed and doing business only in this Commonwealth.
(2) Computes reserves using assumptions and methods used prior to the operative date of the valuation manual in addition to any requirements established by the commissioner and promulgated by regulation.
(b) Written exemption.--
An exemption under subsection (a) that is granted by the commissioner shall be in writing.
(c) Revocation.--
The commissioner may revoke the exemption under subsection (a) if the conditions under subsection (a)(1) and (2) are no longer met after 180 days' written notice to the company regarding the conditions.
(d) Additional effects of exemption.--
A company granted an exemption under subsection (a) shall also be exempt from any requirement under this chapter that is created by a reference to section 7125 or 7126 for the product forms or product lines exempted.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7142 - Small company exemption (Repealed)

§ 7142. Small company exemption (Repealed).
2023 Repeal.
Section 7142 was repealed June 14, 2023, P.L.4, No.2, effective immediately.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 71 - Reserve Liabilities › Section 7143 - Adoption of exemption standards of NAIC Valuation Manual

§ 7143. Adoption of exemption standards of NAIC Valuation Manual.
(a) Findings and declarations.--
The General Assembly finds and declares that the work of NAIC and the participation of the commissioner in NAIC are essential to the general implementation of this chapter.
(b) Standards.--
To effectuate the decision as to whether to exempt certain policies, certificates or products of a particular company from certain provisions of the NAIC Valuation Manual, the commissioner shall determine, on an annual basis, whether to adopt the standards for exemption specified in the most recent version of the NAIC Valuation Manual by submitting a statement of policy to the Legislative Reference Bureau for publication in the next available issue of the Pennsylvania Bulletin.
(c) Statement of policy.--
A statement of policy issued under subsection (b) shall be exempt from the following:
(1) Section 205 of the act of July 31, 1968 (P.L.769, No.240), referred to as the Commonwealth Documents Law.
(2) Section 204(b) and 301(10) of the act of October 15, 1980 (P.L.950, No.164), known as the Commonwealth Attorneys Act.
(3) The act of June 25, 1982 (P.L.633, No.181), known as the Regulatory Review Act.
(d) Construction.--
Nothing in this section shall affect any other provision in this chapter or apply to any action taken by the department prior to the effective date of this section.
(June 14, 2023, P.L.4, No.2, eff. imd.)
2023 Amendment.
Act 2 added section 7143.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 91 - Preliminary Provisions › Section 9102 - Purpose and intent

§ 9102. Purpose and intent.
The General Assembly finds and declares as follows:
(1) The Commonwealth intends to maintain the Commonwealth's sovereignty over the regulation of health insurance in this Commonwealth.
(2) The health insurance marketplace in this Commonwealth is unique and unlike the marketplace in any other state.
(3) It is necessary to maintain the Commonwealth's sovereignty over the regulation of health insurance in this Commonwealth as permitted by Federal law, including the Federal acts. The provisions of this part are intended to meet these requirements while retaining the Commonwealth's authority to regulate health insurance in this Commonwealth.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9303 - Advisory council

§ 9303. Advisory council.
(a) Establishment.--
An advisory council is created to advise the exchange authority under section 9304(g) (relating to meetings and operation).
(b) Composition.--
The advisory council shall consist of the following members, who may not be in the employ of the Commonwealth:
(1) Four consumer representatives which include two representatives appointed by the Governor at least one of whom shall be a registered insurance exchange navigator or assister, one appointed by the President pro tempore of the Senate and one appointed by the Speaker of the House of Representatives.
(2) One representative selected by the Hospital and Healthsystem Association of Pennsylvania.
(3) One representative selected by the Pennsylvania Medical Society.
(4) One representative selected by the Pennsylvania Chamber of Business and Industry from a small group employer.
(5) One representative selected by the Pennsylvania Association of Health Underwriters.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9304 - Meetings and operation

§ 9304. Meetings and operation.
(a) Chairperson.--
The members of the advisory council shall annually elect a chairperson from among its membership.
(b) Terms of members.--
Each member's term shall be four years, not to exceed more than two full consecutive four-year terms, except that:
(1) Initial appointments shall be staggered to ensure less than 50% of the membership expire each year.
(2) A member's term shall continue until the member's successor is appointed.
(c) Meetings.--
All meetings of the advisory council shall be conducted in accordance with 65 Pa.C.S. Ch. 7 (relating to open meetings), except as provided in this section. Meetings must be held in accordance with the following:
(1) The advisory council shall meet at least twice per year, with each meeting held prior to a meeting of the board. Additional meetings may be held upon reasonable notice at times and locations selected by the board. The council shall meet at the call of the chairperson or upon written request of three members of the council.
(2) The executive director of the exchange authority, or a designee, shall attend each meeting of the advisory council.
(3) Meeting dates shall be set by a majority vote of members of the advisory council or by call of the chairperson upon seven days' notice to all members.
(4) The advisory council shall post notice of the council's meetings on the exchange authority's publicly accessible Internet website at least five days prior to each meeting. The notice must specify the date, time and place of the meeting and shall state that the council's meetings are open to the general public.
(5) All action taken by the advisory council shall be taken in open public session and may not be taken except upon a majority vote of the members present at a meeting at which a quorum is present.
(d) Compensation.--
The members of the advisory council shall not be entitled to any compensation for their services as members, except that, subject to the availability of money, the members of the advisory council shall be entitled to reimbursement for actual and necessary travel expenses. The expenses shall be paid for by the exchange fund.
(e) Vacancies.--
Vacancies in appointed positions shall be filled in the same manner as the original appointment. Members shall serve until their successors are appointed and qualified.
(f) Quorum.--
A majority of the advisory council members shall constitute a quorum and a quorum may act for the advisory council in all matters.
(g) Duties.--
Upon request by the exchange authority, the advisory council shall advise the exchange authority on the following administrative and operational decisions:
(1) Initial operational decisions.
(2) Ongoing financing decisions.
(3) Other decisions as the exchange authority may deem appropriate.
Cross References.
Section 9304 is referred to in sections 9303, 9305 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9306 - Limitations

§ 9306. Limitations.
Except as expressly provided in this chapter, nothing in this chapter shall be construed to limit or supersede the authority vested in a Commonwealth agency, including:
(1) The Insurance Department, including the department's authority to regulate the business of insurance within this Commonwealth, including health insurance policies whether offered on or off the exchange.
(2) The Department of Human Services, including with respect to the medical assistance program or the Children's Health Insurance Program.
(3) The Department of Health.
(4) The Office of Attorney General.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9307 - Confidentiality and disclosure

§ 9307. Confidentiality and disclosure.
(a) General rule.--
Except as provided in this chapter, all working papers, recorded information, documents and copies of working papers, recorded information and documents produced by, obtained by or disclosed to the exchange authority or any other person in the course of the exercise of the exchange authority's powers and duties under this chapter:
(1) shall be confidential;
(2) shall not be subject to subpoena;
(3) shall not be subject to the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law;
(4) shall not be subject to discovery or admissible in evidence in any private civil action; and
(5) may not be made public by the exchange authority or any other person.
(b) Personal health and financial information.--
The exchange authority shall protect personally identifiable health and financial information in accordance with all applicable Federal and State laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936), the Health Information Technology for Economic and Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and implementing regulations.
(c) Information disclosure.--
Subject to the confidentiality provisions of this section:
(1) Information shall be shared, as appropriate, for the purpose of determining and coordinating the eligibility of individuals for the exchange or any government program, including the Children's Health Insurance Program and medical assistance program, or for compliance with Federal law:
(i) Among the exchange authority and departments, including:
(A) The department.
(B) The Department of Aging.
(C) The Department of Drug and Alcohol Programs.
(D) The Department of Health.
(E) The Department of Human Services.
(F) The Department of Labor and Industry.
(G) The Department of Revenue.
(ii) Between the exchange authority and Federal agencies, including:
(A) The Centers for Medicare and Medicaid Services.
(B) The Treasury Department.
(2) Information may be disclosed:
(i) As necessary to comply with the audit requirements of section 9310 (relating to audits) and the reporting requirements of section 9311 (relating to reports), only in an aggregated and de-identified form.
(ii) In any circumstance, other than those described in paragraph (1) or subparagraph (i), only if the prior written consent of the company or person to which the information pertains has been obtained.
(d) Construction.--
Nothing in this section shall be construed to prohibit the exchange authority from accessing the information necessary to carry out its responsibilities in accordance with law.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9309 - Nonliability

§ 9309. Nonliability.
(a) General rule.--
Except as provided under subsection (b), there shall be no liability on the part of and no cause of action of any nature may arise against the exchange authority, board or advisory council or members thereof, the commissioner, the department, an insurer, insurance producer or an exchange assister or an authorized representative, agent or employee thereof, for the use of information furnished pertaining to:
(1) An application for, inquiry concerning or enrollment or disenrollment in a health insurance policy or government program, including an inquiry regarding eligibility for enrollment or eligibility for a government program, relevant to health insurance available through an exchange or health care coverage or other benefits through a government program.
(2) A charge, assessment or fee imposed on or received from a person or entity relevant to the exchange.
(b) Limitation.--
Subsection (a) shall apply only insofar as the person or entity is acting within the scope of the person's or entity's duties and responsibilities under this chapter.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9310 - Audits

§ 9310. Audits.
(a) Annual audit.--
The accounts and books of the exchange authority shall be examined and audited annually by an independent certified public accounting firm. The audit shall at a minimum:
(1) Assess compliance with the requirements of this chapter.
(2) Identify any material weaknesses or significant deficiencies and identify ways to correct the material weaknesses or deficiencies.
(b) Sharing of audit.--
By December 31 of each year, the exchange authority shall electronically share the audit of the preceding fiscal year required under subsection (a) and related documents by:
(1) Posting the following on the exchange authority's publicly accessible Internet website:
(i) The audit.
(ii) A summary of the audit, including any material weakness or significant deficiency identified and how the exchange authority intends to correct the material weakness or significant deficiency.
(2) Providing an electronic link to the posted audit under paragraph (1)(i) to the Secretary of the Senate and the Chief Clerk of the House of Representatives.
(3) Providing an electronic link to the posted audit under paragraph (1)(i) to the department.
(c) Payment.--
The cost of the annual audit required under subsection (a) shall be paid for from money in the exchange fund.
Cross References.
Section 9310 is referred to in section 9307 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9311 - Reports

§ 9311. Reports.
(a) Report.--
The exchange authority shall prepare an annual report on the activities of the exchange authority for the year and:
(1) Electronically transmit the report to:
(i) The Governor.
(ii) The President pro tempore of the Senate.
(iii) The Minority Leader of the Senate.
(iv) The Speaker of the House of Representatives.
(v) The Minority Leader of the House of Representatives.
(vi) The chair and minority chair of:
(A) The Appropriations Committee of the Senate.
(B) The Appropriations Committee of the House of Representatives.
(C) The Banking and Insurance Committee of the Senate.
(D) The Insurance Committee of the House of Representatives.
(E) The Health and Human Services Committee of the Senate.
(F) The Health Committee of the House of Representatives.
(2) Post the report on the exchange authority's publicly accessible Internet website.
(b) Federal compliance.--
The exchange authority shall comply with applicable Federal reporting requirements.
(c) Department notification.--
The exchange authority shall provide a copy of or electronic link to the report provided under subsection (a) or (b) to the department.
Cross References.
Section 9311 is referred to in section 9307 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9312 - Exchange fund

§ 9312. Exchange fund.
(a) Establishment.--
The Pennsylvania Health Insurance Exchange Fund is established as a special fund within the State Treasury. The exchange fund shall be administered by the exchange authority for the purposes set forth in this chapter, including the deposit of money that may be received pursuant to and disbursements permitted by this chapter.
(b) Deposit and use of money.--
The following apply:
(1) Money deposited into the exchange fund shall be held for the purposes set forth in this chapter and may not be considered a part of the General Fund.
(2) Money in the exchange fund may only be used to effectuate the purposes of this chapter as determined by the exchange authority.
(3) All interest earned from the investment or deposit of money in the exchange fund shall be deposited into the exchange fund.
(4) All accrued and future earnings from money invested by the exchange authority and other accrued and future earnings from nonappropriated money, including, but not limited to, money obtained from the Federal Government and fees, shall be available to the exchange authority and shall be deposited into the State Treasury and may be utilized at the discretion of the board for carrying out any of the corporate purposes of the exchange authority.
(5) Placement of money by the State Treasurer in depositories or investments shall be consistent with guidelines approved by the board.
(6) For the purpose of administration, the exchange authority shall be subject to sections 610, 613 and 614 of act of April 9, 1929 (P.L.177, No.175), known as The Administrative Code of 1929.
(c) Nonlapsing and revolving fund.--
The exchange fund shall be a nonlapsing fund. All money in the exchange fund and interest accrued are appropriated to the exchange authority for expenditure consistent with this chapter.
Cross References.
Section 9312 is referred to in sections 9103, 9305 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 93 - State-based Exchange › Section 9314 - Expiration

§ 9314. Expiration.
Upon publication of the notice under section 9703(b) (relating to action by commissioner), the exchange authority shall initiate steps to cease operations of the exchange authority and shall cease operations not later than 15 months after publication of the notice.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9501 - Application

§ 9501. Application.
(a) Application.--
The department is authorized to apply to the United States Secretary of Health and Human Services under section 1332 of the Affordable Care Act (Public Law 111-148, 42 U.S.C. § 18052) for a state innovation waiver to:
(1) Waive any applicable provisions of the Affordable Care Act with respect to health insurance coverage in this Commonwealth.
(2) Establish a reinsurance program in accordance with an approved waiver.
(3) Maximize Federal funding for the reinsurance program for plan years beginning on or after implementation of the program.
(b) Public review.--
On or before 180 days after the effective date of this section, the department shall make a draft application available for a 30-day public review and comment period. The department shall consider any comments in its final submitted application.
(c) Amendment.--
The department may amend the waiver application as necessary to carry out the provisions of this chapter.
(d) Notification.--
The department shall notify the chair and minority chair of the Appropriations Committee of the Senate, the chair and minority chair of the Appropriations Committee of the House of Representatives, the chair and minority chair of the Banking and Insurance Committee of the Senate and the chair and minority chair of the Insurance Committee of the House of Representatives promptly of any amendment to the waiver application and of any Federal actions regarding the waiver application.
Cross References.
Section 9501 is referred to in sections 9502, 9512 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9502 - Implementation of waiver and establishment of reinsurance program

§ 9502. Implementation of waiver and establishment of reinsurance program.
(a) Implementation.--
Upon approval of the department's application for an innovation waiver by the United States Department of Health and Human Services, the department shall implement a reinsurance program.
(b) Establishment.--
Contingent upon Federal approval, the Commonwealth Health Insurance Reinsurance Program is established in the department for the purposes of stabilizing the rates and premiums for health insurance policies in the individual market and providing greater financial certainty to consumers of health insurance in this Commonwealth. The reinsurance program shall be considered a reinsurance entity to carry out a reinsurance program under the Federal acts.
(c) Operation.--
Operation of a reinsurance program shall be contingent on Federal approval of the waiver application submitted pursuant to section 9501 (relating to application).
Cross References.
Section 9502 is referred to in sections 9103, 9305, 9510 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9503 - Administration and operation of reinsurance program

§ 9503. Administration and operation of reinsurance program.
(a) General rule.--
The department shall take all actions necessary to administer the approved reinsurance program in a manner consistent with applicable Federal and State law.
(b) Functions.--
The department shall perform all functions necessary and appropriate to carry out the operation of the reinsurance program and to effectuate the purposes for which the reinsurance program is organized, in accordance with the approved waiver. The functions include:
(1) Establishing procedures for and performing administrative and accounting operations of the reinsurance program.
(2) Seeking and receiving funding for the reinsurance program and to maximize Federal funding for the reinsurance program, including from:
(i) The exchange authority.
(ii) Federal funding that is or becomes available to states to support administration and implementation of state-based reinsurance programs.
(iii) Other available sources.
(3) Collecting data submissions and reinsurance payment requests by eligible insurers.
(4) Making reinsurance payments to eligible insurers.
(5) Resolving disputes related to the amount of reinsurance payments.
(6) Suing or being sued, including taking any legal action necessary or proper for the recovery of money for reinsurance payments.
(7) Submitting invoices or other requests for money as may be necessary and appropriate under the innovation waiver.
(c) Delegation.--
Except as prohibited by applicable Federal law and regulation, and as may be necessary or appropriate to carry out department duties, the department may administer the reinsurance program directly or through:
(1) Other Federal agencies, Commonwealth agencies or other states' agencies.
(2) Contracted persons or entities, including with legal, actuarial, economic, third-party administrator or other persons or entities, as the department deems appropriate, to provide consultation services and technical assistance in operating the reinsurance program. Contracted persons or entities shall submit regular reports to the department regarding the person's or entity's performance, the frequency, content and form of which shall be determined by the department.
(d) Coordination with exchange authority.--
The department shall coordinate with the exchange authority as may be necessary to fund and operate the reinsurance program.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9504 - Reinsurance parameters

§ 9504. Reinsurance parameters.
(a) Adoption of reinsurance terms.--
The department shall, after consultation with all insurers then currently participating in the exchange, and not less than 60 days before final rates for health insurance policies are required to be submitted each year, determine and adopt the attachment point, reinsurance cap and coinsurance rate applicable to the reinsurance program for the following year.
(b) Parameters.--
In determining the attachment point, reinsurance cap and coinsurance rate applicable to the reinsurance program for the following year, the department shall seek to:
(1) Manage the program within the amount of total program funding available to the department.
(2) With respect to the individual market:
(i) Mitigate the impact of high-cost claims on premium rates.
(ii) Stabilize or reduce premium rates.
(iii) Increase participation.
(c) Publication and notice.--
The department shall transmit notice of the adopted attachment point, reinsurance cap and coinsurance rate to the Legislative Reference Bureau for publication in the Pennsylvania Bulletin and shall:
(1) Post notice on the department's publicly accessible Internet website.
(2) Electronically send notice to the chair and minority chair of the Banking and Insurance Committee of the Senate and the chair and minority chair of the Insurance Committee of the House of Representatives.
(3) Electronically send notice to each participating insurer via a contact person or electronic mailing address, as identified by the insurer.
(d) Limitation.--
After the department adopts the attachment point, reinsurance cap and coinsurance rate for the next year, the department may not, before or during that benefit year, change the attachment point, reinsurance cap or coinsurance rate in a manner less favorable to the insurers participating in the exchange at the time of adoption.
Cross References.
Section 9504 is referred to in sections 9506, 9512 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9505 - Insurer eligibility and duties

§ 9505. Insurer eligibility and duties.
(a) Eligibility for payment.--
An insurer shall be eligible for a reinsurance payment if:
(1) The claims costs for a reinsurance-eligible enrollee's covered benefits in a benefit year exceed the attachment point.
(2) The eligible insurer has implemented and documented reasonable care management practices for enrollees who are the subject of reinsurance claims through the reinsurance program.
(3) The eligible insurer makes its requests for reinsurance payments in accordance with any requirements established by the department, including requirements related to the format, structure and timing for submission of claims for reinsurance payments.
(4) The eligible insurer participated in the exchange, or is affiliated with an entity that participated in the exchange, in the benefit year in which the claims costs for which a reinsurance payment is sought were incurred.
(b) Reporting requirement.--
An insurer that seeks reinsurance payments under this chapter must report to the department, in the form and manner prescribed by the department, information about reinsurance-eligible enrollees insured by the insurer as necessary for the department to calculate reinsurance payments.
(c) Confidentiality.--
Reinsurance claims submitted under this section are confidential and are not subject to public disclosure, except as provided under section 9514 (relating to immunity).
(d) Consideration for rate filings.--
In a rate filing for a health insurance policy to be offered through the exchange, the impact of reinsurance payments under this chapter shall be identified.
(e) Limitation.--
The calculation of reinsurance payments due to an eligible insurer shall be net of all other available insurance payments applicable to a claim, including insurance accessible through subrogation or coordination of benefits.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9506 - Payment of coverage and administrative costs

§ 9506. Payment of coverage and administrative costs.
(a) General rule.--
Consistent with Federal requirements, the department shall pay the following from the Reinsurance Fund:
(1) Administrative expenses of the reinsurance program, including the annual audit required under section 9508 (relating to annual audit).
(2) Reinsurance payments for coverage of reinsurance-eligible enrollees.
(b) Operations.--
The department may promulgate regulations necessary and appropriate to establish processes for the settlement of reinsurance coverage claims and disbursement of reinsurance money.
(c) Request for review.--
An insurer that is aggrieved by a determination of the department relating to the amount of reinsurance payments due to the insurer may file a request for administrative review of the decision. The procedures and requirements of 2 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of Commonwealth agencies) shall apply to requests for review filed under this section. Notwithstanding otherwise applicable time limitations, in order to permit timely finalization of rates for the open enrollment period for the exchange, a challenge to the department's determination of the attachment point, reinsurance cap and coinsurance rate published in the Pennsylvania Bulletin under section 9504(c) (relating to reinsurance parameters) must be made within 10 business days of the date of publication.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9507 - Not an entitlement

§ 9507. Not an entitlement.
(a) No entitlement.--
The provision of reinsurance program money or benefits accrued through the Reinsurance Fund may not constitute an entitlement derived from the Commonwealth or a claim on any other money of the Commonwealth.
(b) Contingency with respect to Federal money.--
Notwithstanding any provision of this chapter, the department shall have no responsibility to pay reinsurance amounts that would be payable out of Federal money if the Federal Government does not transmit sufficient money for the Reinsurance Fund to fully recompense those actions.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9508 - Annual audit

§ 9508. Annual audit.
(a) Annual audit.--
The reinsurance program shall be examined and audited annually by an independent certified public accounting firm. The audit shall, at a minimum:
(1) Assess compliance with the requirements of this chapter.
(2) Identify any material weaknesses or significant deficiencies and identify and implement solutions to correct the material weaknesses or deficiencies.
(b) Sharing of audit.--
By December 31 of each year, the department shall electronically share the audit of the preceding fiscal year required under subsection (a) and related documents by:
(1) Posting the following on the department's publicly accessible Internet website:
(i) The audit.
(ii) A summary of the audit, including any material weakness or significant deficiency identified and how the department intends to correct the material weakness or significant deficiency.
(2) Providing an electronic link to the posted audit under paragraph (1)(i) to the Secretary of the Senate and the Chief Clerk of the House of Representatives.
(c) Payment.--
The cost of the annual audit required under subsection (a) shall be paid for from money in the Reinsurance Fund.
Cross References.
Section 9508 is referred to in sections 9506, 9513 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9509 - Annual report of operations

§ 9509. Annual report of operations.
(a) Report.--
No later than November 1 of the year following the applicable benefit year or 60 calendar days following the final disbursement of reinsurance payments for the applicable benefit year, whichever is later, the department shall prepare a financial report for the applicable benefit year. The report must include, at a minimum, the following information for the benefit year that is the subject of the report:
(1) Money deposited into the Reinsurance Fund.
(2) Requests for reinsurance payments received from eligible insurers.
(3) Reinsurance payments made to eligible insurers.
(4) Administrative and operational expenses incurred for the reinsurance program.
(b) Comparative report.--
No later than 60 days after individual market health insurance rates are final, the department shall prepare a report summarizing the quantifiable impact of the reinsurance program on individual market health insurance rates for the following plan year.
(c) Distribution of reports.--
The department shall:
(1) Electronically transmit the reports under this section to:
(i) The President pro tempore of the Senate.
(ii) The Minority Leader of the Senate.
(iii) The Speaker of the House of Representatives.
(iv) The Minority Leader of the House of Representatives.
(v) The chair and minority chair of the Appropriations Committee of the Senate and the chair and minority chair of the Appropriations Committee of the House of Representatives.
(vi) The chair and minority chair of the Banking and Insurance Committee of the Senate and the chair and minority chair of the Insurance Committee of the House of Representatives.
(2) Post the reports under this section on the department's publicly accessible Internet website.
Cross References.
Section 9509 is referred to in section 9513 of this title.
2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 40 - INSURANCE › Chapter 95 - Reinsurance Program › Section 9510 - Reinsurance Fund

§ 9510. Reinsurance Fund.
(a) Establishment and administration of Reinsurance Fund.--
The Reinsurance Fund is established as a special fund within the State Treasury. The Reinsurance Fund shall be administered by the department for the purposes set forth in this chapter, including the deposit of Federal money and all other money received pursuant to and disbursements permitted by this chapter.
(b) Exclusive purpose.--
The Reinsurance Fund shall be dedicated exclusively for the reinsurance program established under section 9502(b) (relating to implementation of waiver and establishment of reinsurance program).
(c) Use.--
The following apply:
(1) Expenditures from the Reinsurance Fund shall be used to:
(i) Implement and operate the reinsurance program.
(ii) Make reinsurance payments to eligible insurers under the reinsurance program. Payments to insurers shall be calculated and made on a pro rata basis.
(2) In making expenditures from the Reinsurance Fund, available Federal money must be expended first.
(3) Pending disbursement, money in the Reinsurance Fund shall be invested or reinvested in the same manner as money in the custody of the State Treasurer. All earnings received from the investment or reinvestment of money shall be credited to the Reinsurance Fund.
(d) Expenses.--
All costs and expenses of the reinsurance program shall be paid from the Reinsurance Fund, including compensation of employees and any independent contractors or consultants hired by the department.
(e) Nonlapsing and revolving fund.--
The following apply:
(1) The Reinsurance Fund shall be a nonlapsing fund. All money placed in the Reinsurance Fund and interest accrued are appropriated to the department for expenditure consistent with the provisions of this chapter.
(2) Nothing in this section shall prevent money in the Reinsurance Fund from being used as a revolving fund to cover necessary expenditures if Federal money is requested and committed but not yet received or if other money is committed but not yet received.
(f) Limitations.--
The following limitations apply:
(1) In each fiscal year, the total amount of annual expenditures from the Reinsurance Fund, including administrative and consulting expenses, may not exceed the amount of expected Federal and other money budgeted for deposit in the Reinsurance Fund in that fiscal year.
(2) Notwithstanding any general or specific powers granted to the department under this chapter, whether express or implied, the department may not pledge, in favor of the reinsurance program, the credit or taxing power of the Commonwealth or any political subdivision.
Cross References.
Section 9510 is referred to in section 9305 of this title.