Capital Bluecross v. Pennsylvania Insurance Department

937 A.2d 552, 2007 Pa. Commw. LEXIS 614
CourtCommonwealth Court of Pennsylvania
DecidedNovember 14, 2007
StatusPublished
Cited by20 cases

This text of 937 A.2d 552 (Capital Bluecross v. Pennsylvania Insurance Department) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Capital Bluecross v. Pennsylvania Insurance Department, 937 A.2d 552, 2007 Pa. Commw. LEXIS 614 (Pa. Ct. App. 2007).

Opinion

OPINION BY

Judge SIMPSON.

These most recent administrative agency appeals involving the consolidation of two “blue plans” are the culmination of 12 years of litigation. Most at issue are orders issued by two Insurance Commissioners essentially permitting the 1996 consolidation to the extent renewable under the Insurance Department’s jurisdiction. Nu *559 merous evidentiary and procedural rulings by a hearing examiner are also contested.

In his appeal, Robert B. Sklaroff, M.D. (Dr. Sklaroff), who ostensibly represents himself in written argument but who was represented by counsel at oral argument, petitions for review of a 2006 final order of former Insurance Commissioner M. Diane Koken (2006 Koken Order) that dismissed his challenge to former Commissioner Linda S. Kaiser’s November 1996 decision and order (1996 Approval Order) approving Highmark Inc.’s (Highmark) proposed bylaws and authorizing the change of control of six domestic insurance company subsidiaries (Subsidiaries).

In their appeal, Capital BlueCross and Capital Advantage Insurance Company (collectively, Capital), which did not participate in the administrative proceedings, petition for review of the 2006 Koken Order.

Highmark is the consolidated corporate successor of the former Blue Cross of Western Pennsylvania (Western Blue Cross) and former Pennsylvania Blue Shield (Blue Shield). Highmark intervened in the appeals, and it seeks to quash both appeals.

For the reasons that follow, we deny Highmark’s application to quash Dr. Skla-roffs appeal, but we affirm the 2006 Ko-ken Order on its merits. Because Capital did not seek to participate in the adjudicatory hearing before Commissioner Koken, it waived its opportunity to establish the requisite standing. Therefore, we quash Capital’s appeal.

I. Background

A. Statutory Background

Several statutes are relevant to these appeals. First is the Nonprofit Corporation Law of 1988, 15 Pa.C.S. §§ 5101-5997 (Nonprofit Law), which governs domestic not-for-profit corporations, and assigns administration to the Department of State.

Next is the Health Plan Corporations Act (Blue Plans Act), 40 Pa.C.S. §§ 6101-27, 6301-35, which authorizes the certification and operation of both nonprofit hospital plans (Blue Cross plans) and nonprofit professional health services plans (Blue Shield plans). Among other things, the Blue Plans Act addresses bylaws and the structure of boards of directors of professional health service corporations and general medical service corporations operating Blue Shield plans. Some administration is assigned to the Department of Insurance, and some regulation is assigned to the Department of Health.

Also relevant is the Insurance Holding Companies Act 1 , which generally addresses change of ownership interests of domestic insurers. Significantly, the definition of “Insurer” in Section 1401 of the Insurance Holding Companies Act, 40 P.S. § 991.1401, excludes nonprofit medical and hospital service organizations. Administration resides with the Department of Insurance (Department).

B. Proposed Consolidation

Prior to their consolidation, Western Blue Cross and Blue Shield, organized under the Nonprofit Law, operated as separate nonprofit health plan corporations or “blue plans” as authorized by the Blue Plans Act. Western Blue Cross operated a nonprofit hospital plan. Its plan provided hospitalization coverage in 29 western Pennsylvania counties. Blue Shield operated a nonprofit professional health services plan. Blue Shield’s health services *560 plan provided general medical, dental and optometric coverage statewide.

In 1995, Western Bine Cross and Blue Shield decided to consolidate into a single new corporate entity, “New Blue Cross/ Blue Shield,” later renamed Highmark. To that end, they submitted a proposed consolidation plan to the Department for approval. The consolidation plan included Highmark’s proposed bylaws. A question arose as to which statutes governed different aspects of the consolidation.

The proposed consolidation also resulted in Highmark’s acquisition of control of all or part of Subsidiaries. Pursuant to the Insurance Holding Companies Act, the Department must approve a proposed change in control of domestic insurers. 2

In March 1996, Western Blue Cross and Blue Shield submitted two Form A filings 3 seeking approval for a change in control of Subsidiaries. Thereafter, Commissioner Kaiser held a pre-approval “public informational hearing” on the proposed consolidation. 4 In addition, the Commissioner received written comments from individuals and organizations supporting and opposing the consolidation. At the pre-approval hearing, representatives from Western Blue Cross and Blue Shield spoke regarding the consolidation and change in control of Subsidiaries. The Commissioner then held the record open for additional written comments.

C. 1996 Approval Order

1. Extent of Authority: Subsidiaries and Consolidation

Ultimately, Commissioner Kaiser approved the Form A filings, thereby approving the change in control of Subsidiaries. However, because the Insurance Holding Companies Act excludes “blue plans” from the definition of insurers regulated by that Act, Commissioner Kaiser determined she lacked subject matter jurisdiction under that Act over the consolidation of Western Blue Cross and Blue Shield. She determined the consolidation was instead controlled by the Nonprofit Law, administered by the Department of State.

This was a central decision which was confirmed multiple times throughout these proceedings. Several issues in the current appeal are based on this decision.

2. Competition

Consistent with her decision regarding lack of authority over the consolidation, Commissioner Kaiser determined the competitive standards in Section 1403(d) of the Insurance Holding Companies Act do not apply to the Highmark consolidation. *561 Even assuming they did, the consolidation met those standards.

Also, she determined the Highmark consolidation fulfills the charitable and benevolent purposes of Western Blue Cross and Blue Shield. Highmark, successor to those companies, remains bound by the same Blue Plans Act requirements.

3. Bylaws

Commissioner Kaiser approved High-mark’s bylaws. The Commissioner determined the proposed bylaws complied with the Blue Plans Act provisions regulating a general medical service corporation’s board of directors. See 40 Pa.C.S. § 6328(b).

4. Certificates of Authority

Additionally, Commissioner Kaiser made the following determinations.

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937 A.2d 552, 2007 Pa. Commw. LEXIS 614, Counsel Stack Legal Research, https://law.counselstack.com/opinion/capital-bluecross-v-pennsylvania-insurance-department-pacommwct-2007.