SB 51, the Health Insurance Core Benefits Coverage Act, requires Pennsylvania health insurance companies to cover specific core health benefits in both individual and group plans. It mandates coverage for 10 essential categories, including emergency services, mental health care, prescription drugs, hospitalization, preventive care, and pediatric services (like dental/vision for children). The law ensures plans are at least as comprehensive as those offered in 2018, with the Insurance Department allowed to adjust requirements through regulations. This directly affects insurers and policyholders by standardizing minimum coverage across the state.
HB 1266 requires Pennsylvania hospitals to publicly post detailed pricing information for standard medical services on their websites within six months of the law taking effect. Hospitals must list the full price (gross charge), negotiated prices for each insurance company (with the insurer's name), the minimum and maximum negotiated prices across all insurers, and the cash price for self-pay patients, along with service descriptions and standard billing codes. This transparency requirement applies to all hospitals and hospital systems in Pennsylvania and mandates ongoing disclosure even if federal pricing rules are repealed or no longer enforced.
SB 967 requires most health insurance policies in Pennsylvania to cover diagnostic testing for dyslexia under specific conditions, such as family history, school literacy screening failures, or a pediatrician's recommendation. It mandates coverage for comprehensive neuropsychological exams and related wellness plans, but caps annual benefits at $6,000 (adjusted for inflation), and excludes policies like accident-only, dental, or vision insurance. The law applies to individual and group health plans governed by Pennsylvania insurance regulations, directly affecting insurers and individuals meeting the eligibility criteria. It does not cover treatment, only diagnosis and screening as defined in the bill.
HB 917 repeals Chapter 33 of Pennsylvania's Insurance Code, which previously required insurers offering plans through the state's health insurance exchange to follow specific federal health care law rules regarding abortion coverage. The repealed provisions included a ban on abortion coverage in most plans (except for complications or miscarriage treatment) and an opt-out option for abortion coverage. This bill directly affects insurers and health plans sold through Pennsylvania's health insurance exchange by removing these specific federal compliance requirements. The change eliminates the state's prior restrictions on abortion coverage within qualified health plans.
SB 271 requires Pennsylvania health insurers to cover bariatric surgery and FDA-approved anti-obesity drugs for individuals aged 18 or older. It mandates coverage for treatments meeting standards set by the American Society for Metabolic and Bariatric Surgery or American College of Surgeons, including pre- and post-operative care like nutritional counseling. The law applies to all health insurance policies issued or renewed in Pennsylvania, requiring coverage "to the same extent as for other medically necessary procedures." It specifically abrogates a conflicting regulation (55 Pa. Code § 1121.54(1)) and takes effect 60 days after enactment. This directly affects insurers and Pennsylvania residents seeking obesity-related medical treatments.
HB 2022 amends the Insurance Company Law of 1921 to require casualty insurance policies to cover scalp cooling systems. The bill directly affects insurance companies and policyholders by mandating coverage for this specific medical technology. However, the provided context does not specify the exact mechanisms for implementation, affected insurance types, or patient eligibility details. The bill was referred to the Insurance committee on November 12, 2025, but no further provisions or impacts are described in the available information. The context lacks sufficient detail to describe key mechanisms or concrete policy changes beyond the title.
SB 317 requires most health insurance policies in Pennsylvania to cover eating disorder treatment, directly affecting people with conditions like anorexia, bulimia, or binge-eating disorder. The bill mandates coverage for inpatient care, residential treatment, counseling, and specialized nutrition services provided by licensed professionals, as defined in the law. Insurers cannot deny coverage based solely on weight, prior treatment history, or attempt to steer patients toward less comprehensive care. This applies to individual and group health plans (excluding limited coverage types like dental or accident-only policies) and takes effect within 60 days of enactment.
SB 461 requires health insurance policies in Pennsylvania to cover specific diagnostic tests and treatments for Lyme disease and related tick-borne illnesses. It directly affects all Pennsylvanians with health insurance, particularly those in the state’s high-risk areas (all 67 counties, per the bill’s findings). The key provision mandates insurers cover clinically appropriate diagnostics and antibiotics, including longer-term treatments that some patients require. The bill aims to improve access to care by eliminating coverage barriers, as Pennsylvania has the highest Lyme disease incidence in the U.S. (over 100,000 cases reported in 2018 alone). This is intended to reduce chronic cases and overall disease burden, aligning with the state’s legislative purpose to promote prevention and treatment access.
HB 281 requires health insurance policies in Pennsylvania to cover prostate cancer screenings with no out-of-pocket costs for men aged 40+ who are at high risk. High-risk individuals include those with a family history of prostate cancer, genetic factors, or physician-determined medical need. The law mandates annual coverage for screenings like PSA tests and digital rectal exams, eliminating deductibles or copays. It applies to all health insurance policies issued or renewed 180 days after enactment, with full implementation in 60 days. This directly affects insurers, healthcare providers, and Pennsylvania residents meeting the specified risk criteria.
HB 544, the Health Care Practitioner Credentialing Act, requires all health insurers in Pennsylvania to accept the CAQH credentialing application (or a nationally recognized alternative) for health care practitioners seeking to join insurer networks. It sets clear timelines: insurers must notify practitioners within 10 business days if an application is incomplete, and make a final credentialing decision within 45 business days of receiving a complete application. The bill also mandates automatic credentialing for practitioners with multi-location practices and imposes penalties on insurers that fail to use CAQH or delay the process. It does not guarantee network access but standardizes the application and review process for practitioners and insurers.
