Pennsylvania exchange would require enrollee proof and investigate suspected fraud

The exchange board would establish an Office of Fraud Prevention to receive and investigate reports and complaints of suspected fraud. The office would create an insurer reporting form and procedures for resolving allegations, including law-enforcement referrals when required. The exchange would certify that each employee received anti-fraud training during the prior calendar year. The yearly report would give legislative leaders fraud totals and copies of the exchange's reporting forms, policies, and procedures. The act would take effect 30 days after enactment, and the board would then have no more than 180 days to open the office. Reports would be due by each November 30.

The exchange authority would review an insurer's request to rescind, or cancel, a policy. These deadlines would apply whenever the exchange receives a rescission request from an insurer. The exchange would respond within one business day after receiving the request and make its final decision within five business days.

The definition would require an enrolled person to provide eligibility documents to the exchange before counting as an enrollee under these insurance rules. It would cover people enrolled to receive health care through a health insurance policy governed by this part. The person would provide proof of Pennsylvania residency. The person would also document citizenship, lawful U.S. presence, or other eligibility under federal law to buy a health reimbursement arrangement. If enacted, this definition would take effect 30 days after enactment.