SB 1439

                                                PRINTER'S NO.   1907
                THE GENERAL ASSEMBLY OF PENNSYLVANIA
                   SENATE BILL
                   No. 1439
                                          Session of
                                            2026
INTRODUCED BY PENNYCUICK, GEBHARD, PHILLIPS-HILL, STEFANO,
   VOGEL, CULVER AND J. WARD, AUGUST 19, 2026
REFERRED TO BANKING AND INSURANCE, AUGUST 19, 2026
                               AN ACT
1 Amending Title 40 (Insurance) of the Pennsylvania Consolidated
2    Statutes, in preliminary provisions relating to health
3    insurance markets oversight, further providing for
4    definitions; and, in State-based exchange, further providing
5    for powers and duties of exchange authority and for reports.
6    The General Assembly of the Commonwealth of Pennsylvania
7 hereby enacts as follows:
8    Section 1.    The definition of "enrollee" in section 9103 of
9 Title 40 of the Pennsylvania Consolidated Statutes is amended to
10 read:
11 § 9103.    Definitions.
12    Subject to additional definitions contained in subsequent
13 provisions of this part which are applicable to specific
14 provisions of this part, the following words and phrases when
15 used in this part shall have the meanings given to them in this
16 section unless the context clearly indicates otherwise:
17    * * *
18    "Enrollee."    A policyholder, certificate holder, subscriber,
19 covered person or other individual who:
1(1)   is enrolled to receive health care services pursuant
2    to a health insurance policy[.]; and
3(2)   has provided documentary evidence of the following
4    to the exchange authority:
5(i)    Residency in this Commonwealth.
6(ii)    Citizenship, lawful presence in the United
7States or other eligibility to purchase a health
8reimbursement arrangement under Federal law.
9    * * *
10    Section 2.  Sections 9305 and 9311 of Title 40 are amended by
11 adding subsections to read:
12 § 9305.    Powers and duties of exchange authority.
13    * * *
14    (d)    Insurer rescission requests.--Upon receiving a request
15 for rescission from an insurer, the exchange authority shall:
16(1)   respond to the request within one business day of
17    receiving the request; and
18(2)   make a final determination on the request within
19    five business days.
20    (e)    Office of Fraud Prevention.--No later than 180 days
21 after the effective date of this subsection, the board shall
22 establish within the exchange authority the Office of Fraud
23 Prevention, which shall:
24(1)   Receive and investigate reports and complaints of
25    suspected fraud.
26(2)   Create a standardized form by which an insurer shall
27    report suspected fraud to the exchange authority.
28(3)   Develop policies and procedures by which the
29    exchange authority shall:
30(i)    report and resolve allegations of fraud,
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1including any required referral of suspected fraud to the
2appropriate law enforcement agency, including the Office
3of Attorney General, the United States Department of
4Justice and the Internal Revenue Service; and
5(ii)    certify that each employee of the exchange
6authority has received anti-fraud training during the
7prior calendar year.
8 § 9311.    Reports.
9    * * *
10    (d)    Fraud report.--By November 30, 2026, and by November 30
11 of each subsequent year, the exchange authority shall submit an
12 annual report to the President pro tempore of the Senate and the
13 Speaker of the House of Representatives, which shall include the
14 following:
15(1)   The following data relating to suspected fraud:
16(i)    For the prior calendar year, the number of
17suspected fraud reports received and the total dollar
18amount of the suspected fraud.
19(ii)    For the prior calendar year, the number of
20confirmed fraud reports and the total dollar amount of
21the confirmed fraud.
22(iii)    The total dollar amount of advance premium tax
23credits provided to rescinded policies during the prior
24calendar year.
25(2)   A copy of the standardized form created under
26    section 9305(e)(2) (relating to powers and duties of exchange
27    authority).
28(3)   A copy of any policy or procedure adopted to
29    implement the requirements related to rescission requests
30    under section 9305(d).
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1(4)   A copy of any policy or procedure developed and
2   adopted under section 9305(e)(3).
3(5)   A copy of any procedure that has been implemented to
4   address suspected fraud and fraud prevention during the prior
5   calendar year.
6   Section 3.    This act shall take effect in 30 days.
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