PRIOR PRINTER'S NO. 1968
PRINTER'S NO. 2787
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1664
Session of
2023
INTRODUCED BY SCOTT, PIELLI, MADDEN, SANCHEZ, HILL-EVANS,
BENHAM, PISCIOTTANO, DALEY, BOROWSKI, CERRATO, CONKLIN, GREEN
AND KHAN, SEPTEMBER 12, 2023
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, MARCH 25, 2024
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for payment choice.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 47
PAYMENT CHOICE
Sec.
4701. Definitions.
4702. Payment.
4703. Regulations.
4704. Enforcement.
§ 4701. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
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context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Credit card payment." A type of electronic funds transfer
in which a dental insurer or its contracted vendor issues a
single-use series of numbers associated with the payment of
covered dental services performed by a dentist and chargeable at
a predetermined rate for which the dentist is responsible for
processing the payment by a credit card terminal or Internet
portal. The term includes virtual or online credit card payments
for which no physical card is presented to the dentist and the
single-use credit card expires upon payment processing.
"Dental insurance policy." An insurance policy that pays or
provides dental expense benefits for covered dental services and
is delivered or issued for delivery by, or through a dental
insurer. The term includes coverage for dental benefits issued
either on a stand-alone basis or integrated, or otherwise
incorporated into the terms and coverage of a health benefits
plan.
"Dental insurer." An entity that offers, issues or renews a
dental insurance policy that covers dental services provided by
a dentist and that is governed under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) Chapter 61 (relating to hospital plan corporations).
(4) Chapter 63 (relating to professional health services
plan corporations).
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"Dentist." A person licensed by the State Board of Dentistry
to provide dental services. The term does not include a dental
hygienist as defined in section 2 of the act of May 1, 1933
(P.L.216, No.76), known as The Dental Law.
"Dentist agent." A person who establishes a contractual
arrangement with a dentist to process bills for services
provided by the dentist under terms and conditions established
between the agent and dentist. The contracts may permit the
dentist agent to submit bills, request reconsideration and
receive reimbursements.
"Electronic funds transfer." A payment of any method of
electronic funds transfer other than through the Automated
Clearing House Network, as codified in 45 CFR 162.1601 (relating
to health care electronic funds transfers (EFT) and remittance
advice transaction) and 162.1602 (relating to Standards for
health care electronic funds transfers (EFT) and remittance
advice transaction).
"MERCHANT SERVICER." ANY OF THE FOLLOWING, AS DEFINED IN 26
U.S.C. § 6050W(B) (RELATING TO RETURNS RELATING TO PAYMENTS MADE
IN SETTLEMENT OF PAYMENT CARD AND THIRD PARTY NETWORK
TRANSACTIONS):
(1) A PAYMENT SETTLEMENT ENTITY.
(2) A MERCHANT ACQUIRING ENTITY.
(3) A THIRD-PARTY SETTLEMENT ORGANIZATION.
§ 4702. Payment.
(a) Payment.--A dental insurer or its contracted vendor may
not restrict the method of payment to a dentist so that the
exclusive payment method is a credit card payment.
(b) Changing payment.--If initiating or changing payments to
a dentist using electronic funds transfer payments, including
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credit card payments, a dental insurer or its contracted vendor
shall:
(1) Advise the dentist of all available payment methods.
(2) Notify the dentist of any fees imposed by the dental
insurer or through its contracted vendor. A contracted vendor
shall not include a financial institution chosen by the
dentist.
(2) NOTIFY THE DENTIST THAT FEES IMPOSED BY THE DENTAL
INSURER OR ITS CONTRACTED VENDOR MAY APPLY TO ELECTRONIC
FUNDS TRANSFER PAYMENTS OR CREDIT CARD PAYMENTS AND PROVIDE
INSTRUCTIONS AND CONTACT INFORMATION SO THAT THE DENTIST MAY
OBTAIN THE EXACT AMOUNT OF THE FEES. FEES CHARGED BY A
FINANCIAL INSTITUTION OR MERCHANT SERVICER CHOSEN BY THE
DENTIST SHALL NOT BE INCLUDED FOR THE PURPOSES OF THIS
PARAGRAPH.
(3) Provide clear instructions to the dentist for the
process of selecting a payment method.
(4) Not charge a fee solely to transmit the payment to
the dentist, unless the dentist has consented to the fee.
(c) Fees.--
(1) A dental insurer or its contracted vendor that
initiates or changes payments to a dentist through the
Automated Clearing House Network, as defined in 45 CFR
162.1601 (relating to health care electronic funds transfers
(EFT) and remittance advice transaction) and 162.1602
(relating to Standards for health care electronic funds
transfers (EFT) and remittance advice transaction), shall not
charge a fee solely to transmit the payment to the dentist
unless the dentist has consented to the fee.
(2) A dentist agent may charge reasonable fees to a
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dentist for Automated Clearing House Network payments related
to transaction management, data management, portal services
and other value-added services in addition to the bank
transmittal.
(d) Waiver prohibited.--The provisions of this section may
not be waived by contract, and any contractual clause in
conflict with the provisions of this section or that purport to
waive any requirements of this section are void.
§ 4703. Regulations.
The department may promulgate necessary and appropriate
regulations to implement this chapter.
§ 4704. Enforcement.
(a) Penalties.--Upon satisfactory evidence of the violation
of any section of this chapter by a dental insurer or any other
person, one or more of the following penalties may be imposed at
the commissioner's discretion:
(1) A fine of not more than $5,000 for each violation of
this chapter.
(2) A fine of not more than $10,000 for each willful
violation of this chapter.
(b) Limitations.--
(1) Fines imposed against an individual insurer under
this chapter may not exceed $500,000 in the aggregate during
a single calendar year.
(2) Fines imposed against any other person under this
chapter may not exceed $100,000 in the aggregate during a
single calendar year.
(c) Additional remedies.--The enforcement remedies imposed
under this subsection are in addition to any other remedies or
penalties that may be imposed under any other applicable law of
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this Commonwealth, including:
(1) The act of July 22, 1974 (P.L.589, No.205), known as
the Unfair Insurance Practices Act. Violations of this
chapter shall be deemed to be an unfair method of competition
and an unfair or deceptive act or practice under that act.
(2) The act of December 18, 1996 (P.L.1066, No.159),
known as the Accident and Health Filing Reform Act.
(3) The act of June 25, 1997 (P.L.295, No.29), known as
the Pennsylvania Health Care Insurance Portability Act.
(d) Administrative procedure.--The administrative provisions
of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies). A
party against whom penalties are assessed in an administrative
action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
Ch. 7 Subch. A (relating to judicial review of Commonwealth
agency action).
Section 2. This act shall apply to contracts offered,
entered, issued or renewed after the effective date of this
section.
Section 3. This act shall take effect in 60 days.
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