Pennsylvania Senate Bill 1439 tightens oversight of the state's health insurance exchange by requiring insurers to provide documentary proof of residency and legal status for every enrollee. The bill mandates that the exchange authority respond to insurer requests to cancel policies within one business day and make a final decision within five business days. Additionally, it requires the creation of an Office of Fraud Prevention within 180 days to investigate complaints, standardize reporting forms, and ensure staff receive annual anti-fraud training. The exchange authority must also submit an annual report to state legislators detailing fraud statistics, financial impacts, and implemented procedures.
Michigan Senate Bill 1136 amends state law to cap the amount public employers can spend on employee health insurance, introducing new fixed dollar limits for single, couple, and family coverage starting in 2027. The bill also reverses a previous provision that allowed employers to pay no more than 80% of total medical costs, instead mandating that they pay at least 80% of those expenses beginning in the same year. These new financial caps are adjusted annually based on changes in Michigan health insurance rates or a minimum 3% increase, whichever is higher. Existing collective bargaining agreements that conflict with these limits are exempt until their current terms expire or are renegotiated.
The TRUTH in Coverage Act of 2026 requires group health plans and health insurance issuers that cover gender-affirming procedures to also cover medical services aimed at treating the physical and psychological harms caused by those procedures. This mandate applies regardless of whether the original procedure was covered under the plan and ensures that follow-up care has the same cost-sharing rules and limitations as other standard medical benefits. The bill defines "sex-rejecting procedures" broadly to include hormone therapy, surgeries, and puberty blockers, while explicitly excluding treatments for intersex conditions, precocious puberty, and emergency care. Coverage for these restorative services would become effective for plan years starting on or after January 1, 2027.
The Employer Health Plan Flexibility Act would allow certain employer-sponsored group health plans to opt out of the Affordable Care Act's requirement to cover specific Essential Health Benefits. This exemption applies to plans governed by the Employee Retirement Income Security Act and would take effect for plan years starting on or after January 1, 2028. While exempt from those specific coverage mandates, the bill explicitly states that employers must still comply with other federal rules, including those regarding mental health parity, nondiscrimination, and preventive services. To ensure transparency, employers claiming this exemption must annually inform their employees about the benefits included in their plan and identify any Essential Health Benefits that are not covered.
