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.
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 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 bill creates a new crime called aggravated assault of an insured, which applies specifically to the chief executive officers of health insurers. Under the law, a CEO would be guilty of this offense if they deny a medically necessary benefit to a patient, and that denial directly causes serious bodily injury or death to the patient. The legislation defines "health insurer" to include various types of medical coverage providers while excluding policies like dental, vision, and workers' compensation plans. If passed, the bill would take effect 60 days after its enactment.
This bill requires health insurance plans in Pennsylvania to credit money that policyholders spend on prescription drugs toward their annual out-of-pocket maximums. The law applies to anyone enrolled in a health benefit plan who pays directly for medications at a pharmacy or through a discount program, regardless of whether the pharmacy has a contract with the insurer. To receive this credit, individuals must submit proof of purchase, and the credit counts toward deductibles, copayments, and coinsurance for the year the expense was incurred. The legislation also establishes a process for insurers to submit regulations and outlines penalties for failing to comply with these new requirements.
This bill establishes the Firefighter Cancer Screening Program and a dedicated fund to help Pennsylvania firefighters cover out-of-pocket costs for cancer screenings. The program is administered by the Insurance Department and specifically targets eligible firefighters, including those in airport fire companies that meet certain mutual aid and response criteria. Funding for these screenings will come from the Budget Stabilization Reserve Fund, which the bill modifies to allow for this specific expenditure. The legislation defines eligible participants and approved screening methods, such as magnetic resonance imaging or ultrasound, while excluding those who already have comprehensive health insurance coverage.
This bill prohibits licensed health insurers in Pennsylvania from increasing costs such as premiums, copayments, coinsurance, or deductibles for specific health care services that were already covered under a policy. The law applies to individual and group health insurance plans but excludes self-funded employer plans and other limited benefit policies. Insurers may still raise costs if a service was obtained through fraud or if the U.S. Food and Drug Administration issues a warning about safety or if a drug manufacturer announces a discontinuance. Violations of these rules would be treated as unfair trade practices and could result in a civil penalty of up to $1,000 for the insurer.
This bill requires insurance companies in Pennsylvania to contract with behavioral health care providers who meet specific criteria, such as being licensed in good standing and offering services within the state. The law mandates that insurers cannot deny network participation to qualified providers who agree to standard contract terms, ensuring patients have access to a wider range of mental health and substance use disorder specialists. Additionally, the legislation establishes rules for claim handling and prohibits discrimination based on the type of behavioral health service provided. By creating these new requirements, the bill aims to remove barriers that might prevent individuals from finding suitable care within their insurance networks.
This bill amends Pennsylvania's Insurance Company Law to require health insurers and managed care plans to include specific clinical review criteria in their medical policies. The key provision mandates that these policies cannot exclude, restrict, or delay coverage for prescription drugs solely because they received expedited FDA approval for serious or life-threatening conditions. Directly affecting insurance companies and managed care organizations, the law aims to ensure access to newly approved treatments without artificial barriers based on the speed of regulatory approval. The changes become effective 60 days after the bill is enacted.
This Pennsylvania bill requires health insurance companies to cover fertility preservation services for individuals facing medically necessary cancer treatments that could cause infertility. The law mandates that insurers include at least three years of egg, sperm, or ovarian tissue storage at an in-network facility, with a minimum lifetime benefit of $100,000 per person. While the coverage must follow standard policy rules like deductibles and copayments, religious employers are allowed to request exemptions if the services conflict with their beliefs, provided they notify patients and allow them to buy separate supplemental insurance.
