Insurance

Pennsylvania House Bill 2734 requires health insurance companies to cover FDA-approved diagnostic tests and treatments that slow the progression of Alzheimer's disease and related dementias. The mandate applies to insurers offering individual or group health policies in the state, with a compliance deadline of January 1, 2028, unless federal law preempts the requirement. The bill explicitly prohibits insurers from using step therapy for these specific treatments, meaning patients cannot be forced to try other medications first before receiving coverage for approved Alzheimer's therapies.

This bill requires dental insurance companies in Pennsylvania to create secure online portals that give dental providers and their staff daily access to detailed patient benefit information, including claims history and denial reasons. The legislation mandates that any verbal or written statements made by insurers regarding benefits or costs must be binding on future claims, with specific exceptions for fraud or eligibility changes. To enforce these rules, the bill allows providers to sue for the original billed amount if insurers fail to pay within 30 days and imposes administrative fines of up to $10,000 for non-compliance. The changes are designed to increase transparency and reduce billing disputes, and they will take effect one year after the bill is enacted.

This bill requires health insurance policies in Pennsylvania to cover at least two epinephrine delivery systems, such as EpiPens, for an annual maximum cost of $35 regardless of deductibles or copayments. It applies to standard medical insurance plans but excludes limited coverage types like dental-only or accident policies. Additionally, the state Insurance Department must investigate manufacturer pricing practices and submit a public report with recommendations to control costs within one year. Insurance companies are also permitted to offer lower out-of-pocket costs than the $35 cap if they choose.

This resolution directs the Legislative Budget and Finance Committee to study the potential financial impact on Pennsylvania if the federal government requires the state to pay for certain health insurance mandates. The bill responds to a proposed federal policy change that could end previous exemptions allowing states to avoid these costs. The study will identify specific health benefits mandated by the state since 2011, analyze their compliance with federal rules, and estimate the resulting expenses for the Commonwealth. The committee is also instructed to gather necessary data from the Insurance Department and deliver a report with findings and recommendations to the General Assembly within one year.

This bill requires health insurance plans in Pennsylvania to cover specific preventive services without charging patients any deductibles, copayments, or coinsurance. The list of covered services is primarily based on recommendations from federal health organizations, such as the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices, and is managed by the state Department of Health. While most standard health plans must comply with these requirements, the law explicitly excludes "grandfathered" plans that existed before the bill takes effect. The legislation also establishes a process for the state to add new preventive services or remove existing ones based on current medical evidence and expert recommendations.