The following words and terms, when used in this chapter,
have the following meanings, unless the context clearly indicates otherwise:
Act-The Insurance Department Act of 1921
(40
P. S. §§
1-321).
Annual receipts-Premium, commissions, fees
or operating revenue received in a 12-month period.
Commissioner-The Insurance Commissioner of
the Commonwealth.
Company-A corporation, limited liability
company, business trust, general or limited partnership, association, sole
proprietorship or similar organization.
Consumer-
(i) An individual, or that individual's legal
representative, who seeks to obtain, obtains or has obtained an insurance
product or service from a licensee that is to be used primarily for personal,
family or household purposes, and about whom the licensee has nonpublic
personal health information. Examples include:
(A) An individual who provides nonpublic
personal health information to a licensee in connection with obtaining or
seeking to obtain financial, investment or economic advisory services relating
to an insurance product or service, regardless of whether the licensee
establishes an ongoing advisory relationship.
(B) An applicant for insurance prior to the
inception of insurance coverage.
(C) A beneficiary of a life insurance policy
underwritten by the licensee.
(D) A
claimant under an insurance policy issued by the licensee.
(E) An insured under an insurance policy or
an annuitant under an annuity issued by the licensee.
(F) A mortgagor of a mortgage covered under a
mortgage insurance policy.
(G) A
participant or a beneficiary of an employee benefit plan that the licensee
administers or sponsors or for which the licensee acts as a trustee, insurer or
fiduciary.
(H) An individual
covered under a group or blanket insurance policy or group annuity contract
issued by the licensee.
(I) A
claimant in a workers' compensation plan.
(ii) Examples of persons who are not
consumers are as follows:
(A) An individual is
not a consumer solely because the individual is a beneficiary of a trust for
which the licensee is a trustee.
(B) An individual is not a consumer solely
because the individual has designated the licensee as trustee for a
trust.
(C) An individual who is a
consumer of another financial institution is not a licensee's consumer solely
because the licensee is acting as agent for, or provides processing or other
services to, that financial institution.
Department-The Insurance Department of the
Commonwealth.
Federal regulation-The Federal Health
Insurance Portability and Accountability Act (HIPAA) privacy regulation as
promulgated by the United States Department of Health and Human Services in 45
CFR Parts 160-164.
Financial institution-
(i) An institution the business of which is
engaging in activities that are financial in nature or incidental to the
financial activities as described in section 4(k) of the Bank Holding Company
Act of 1956 (12 U.S.C.A.
§
1843(k)).
(ii) The term does not include the following:
(A) A person or entity with respect to a
financial activity that is subject to the jurisdiction of the Commodity Futures
Trading Commission under the Commodity Exchange Act (7 U.S.C.A. §§
1-
25).
(B) The Federal Agricultural Mortgage
Corporation or an entity charged and operating under the Farm Credit Act of
1971 (12 U.S.C.A.
§§
2001-
2279cc).
(C) Institutions chartered by Congress
specifically to engage in securitizations, secondary market sales (including
sales of servicing rights) or similar transactions related to a transaction of
a consumer, as long as the institutions do not sell or transfer nonpublic
personal information to a nonaffiliated third party.
Health care-
(i) Preventative, diagnostic, therapeutic,
rehabilitative, maintenance or palliative care, services, procedures, tests or
counseling that either:
(A) Relates to the
physical, mental or behavioral condition of an individual.
(B) Affects the structure or function of the
human body or a part of the human body, including the banking of blood, sperm,
organs or other tissue.
(ii) Prescribing, dispensing or furnishing to
an individual drugs or biologicals, or medical devices or health care equipment
and supplies.
Health care provider-
(i) A physician or other health care
practitioner licensed, accredited or certified to perform specified health
services consistent with the laws of the Commonwealth.
(ii) A health care facility.
Health information-Information or data
except age, gender or nonpublic personal financial information, whether oral or
recorded in a form or medium, created by or derived from a health care provider
or the consumer that relates to one or more of the following:
(i) The past, present or future physical,
mental or behavioral health or condition of an individual.
(ii) The provision of health care to an
individual.
(iii) Payment for the
provision of health care to an individual.
Insurance product or service-A product or
service that is offered by a licensee under the insurance laws of the
Commonwealth. Insurance service includes a licensee's evaluation, brokerage or
distribution of information that the licensee collects in connection with a
request or an application from a consumer for an insurance product or
service.
Licensee-
(i) A licensed insurer, as defined in section
201-A of the act (40 P. S. §
65.1-A), a
producer and other persons or entities licensed or required to be licensed, or
authorized or required to be authorized, or registered or required to be
registered under the act or The Insurance Company Law of 1921 (40 P. S.
§§
361-991.2361), including health
maintenance organizations holding a certificate of authority under section 201
of the Health Care Facilities Act (35 P. S. §
448.201).
(ii) The term does not include:
(A) Bail bondsmen as defined in
42 Pa.C.S. §
5741
(relating to definitions).
(B)
Motor vehicle physical damage appraisers as defined in section 2 of the Motor
Vehicle Physical Damage Appraiser Act (
63 P. S. §
852) and §
62.1 (relating to
definitions).
(iii)
Subject to subparagraph (iv), the term does not include governmental health
insurance programs such as the following:
(A)
The Children's Health Insurance Program as provided for in the Children's
Health Care Act (40 P. S. §§
991.2301-991.2361).
(B) The Medicaid program as provided for in
sections 441.1 -453 of the Public Welfare Code (62 P. S. §§
441.1-453).
(C) The Medicare+Choice program as provided
for in the Balanced Budget Act of 1997, sections 1851-1859, Medicare Part C
under Title XVIII of the Social Security Act (42 U.S.C.A. §§
1395w-21-
1395 w-29).
(D) The Adult Basic Care program as provided
for in the Tobacco Settlement Act. See section 1303 of the Tobacco Settlement
Act (35 P. S. §
5701.1303).
(iv) The term includes a licensee that
enrolls, insures or otherwise provides an insurance related service to
participants that procure health insurance through a governmental health
insurance program exempted under subparagraph (iii).
(v) Subject to subparagraph (ii), the term
"licensee" shall also include a nonadmitted insurer that accepts business
placed through a surplus lines licensee (as defined in section 1602 of The
Insurance Company Law of 1921 (40 P. S. §
991.1602) in this Commonwealth, but only in
regard to the surplus lines placements placed under Article XVI of The
Insurance Company Law of 1921 (40 P. S. §§
991.1601-991.1625).
Nonpublic personal financial
information-As defined in §
146a.2 (relating to
definitions).
Nonpublic personal health
information-
(i) The term
means either of the following:
(A) Health
information that identifies an individual who is the subject of the
information.
(B) Health information
that there is a reasonable basis to believe could be used to identify an
individual.
(ii) The term
does not include nonpublic personal financial information.
Producer-An insurance agent or broker
licensed or required to be licensed by the Department under the
act.
