Healthcare (Insurance)

HB 1301 requires all health insurance policies sold in Pennsylvania to cover pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) HIV medications, along with associated lab tests and doctor visits for counseling or prescription, with no copays, deductibles, or coinsurance. It prohibits insurers from placing PrEP/PEP services in specialty tiers for profit and bans requiring specialist counseling unless medically necessary. The law applies to all health insurance policies issued or renewed in Pennsylvania after its effective date (60 days from passage), including group and individual plans regulated under state insurance laws. This directly affects Pennsylvanians with health insurance who need HIV prevention or treatment services, ensuring full coverage without out-of-pocket costs.

Senate Resolution 96 recognizes May 2025 as "Mental Health Awareness Month" in Pennsylvania. This resolution also states the Senate's intent to pursue policies that promote mental health for all residents, aiming for parity with physical health in resources, education, treatment, and insurance coverage.

HB 1123 updates Pennsylvania's 1921 Insurance Company Law to require casualty insurance policies to cover colorectal cancer screening without cost-sharing. This affects insured residents in Pennsylvania who need preventive screenings, ensuring they face no copays or deductibles for this specific health service. The key provision mandates insurers to include coverage for colon cancer screenings as a standard benefit under casualty insurance policies. The bill passed final passage on October 29, 2025, and is now pending implementation under the Banking & Insurance committee. This change directly removes financial barriers for early detection of colorectal cancer through existing insurance coverage.

HB 397 (Pennsylvania) allows volunteer fire companies to directly bill insurers for emergency medical services provided by certified EMT firefighters during dispatched emergencies. It affects volunteer fire companies and insurers covering emergency medical services under health insurance policies. The bill enables fire companies to submit separate claims for services rendered at emergency scenes, prohibits insurers from requiring contracts for payment, and imposes fines for false claims ($100 for first offense, $1,000 for repeat). This amendment to the 1921 Insurance Company Law clarifies billing procedures for EMT firefighters without changing existing insurance coverage requirements.

SB 53 requires health insurance policies in Pennsylvania to cover children up to age 26, extending the previous limit of 19. It prohibits insurers from denying or restricting coverage based on factors like marital status, education, employment, or residency. The law applies to standard health insurance policies (excluding dental, disability, hospital indemnity, and similar plans) and mandates continued coverage for adult children meeting specific criteria, such as not being married or having dependents. This directly affects policyholders and their children aged 19-26 who would otherwise lose coverage.

HB 1033 prohibits healthcare providers from performing gender transition procedures on minors under 18, including surgeries, cross-sex hormones, and puberty blockers. It also requires government health programs (like Medicaid) and health insurance policies to stop covering these procedures for minors. The bill defines "gender transition procedures" to include genital/nongenital surgeries, cross-sex hormones, and puberty blockers. Individuals aged 18 or older are not affected by the ban and may continue receiving such care.