Healthcare (Insurance)

in committee · Pennsylvania · Senate Jun 24, 2025

SB 850: An Act amending the act of November 3, 2022 (P.L.2135, No.150), known as the Childhood Blood Lead Test Act, further providing for legislative purpose, for definitions, for lead poisoning prevention, assessment and testing and for blood lead assessment and testing coverage.

SB 850 amends Pennsylvania's Childhood Blood Lead Test Act to require all children under 72 months to receive at least one blood lead test by age 2 (or by 72 months if never tested), and mandates confirmatory testing if initial results indicate elevated lead levels. It directly affects children under 72 months and pregnant women, ensuring no out-of-pocket costs (like copays or deductibles) for covered blood lead tests. The bill updates testing requirements to be mandatory (replacing "encourage" with "require") and clarifies that health insurance must cover these tests without cost-sharing. These changes aim to improve early detection of lead exposure, a preventable health risk linked to developmental issues in young children.

Topics ✓ HealthcareSupports HealthcareMandates free blood lead testing for children under 72 months, removing financial barriers to preventive healthcare access.95% confidence

Sub-Topics Insurance

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passed · Pennsylvania · House Mar 25, 2025

HB 535: An Act providing for health care insurance coverage protections; imposing duties on the Insurance Department and the Insurance Commissioner; and imposing penalties.

HB 535 bans Pennsylvania health insurers from setting annual or lifetime dollar limits on core health benefits for enrollees, whether services are provided by in-network or out-of-network providers. It applies to all individual and group health insurance policies (excluding specific types like Medicare supplements or dental/vision-only plans) and prohibits limits on benefits that were already covered without such caps in 2025 policies. The Insurance Department can enforce this through fines up to $5,000 per violation (or $10,000 for willful violations), with annual caps of $500,000 for insurers. The law does not require coverage of specific benefits but eliminates existing dollar limit practices for covered services.

Topics ✓ HealthcareSupports HealthcareBans insurers from imposing annual/lifetime dollar limits on core health benefits, protecting patient access to essential care without financial caps.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentBans health insurers from capping core benefits, expanding worker health coverage protections under employment standards as a key benefit.90% confidence

Sub-Topics Insurance Medicare

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in committee · Pennsylvania · Senate Feb 26, 2025

SB 318: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for postacute neurorehabilitation.

SB 318 requires most health insurance policies in Pennsylvania to cover postacute neurorehabilitation services for individuals with acquired brain injuries. This includes specific therapies like cognitive rehabilitation, neurobehavioral treatment, community reintegration, and day rehabilitation programs, as determined medically necessary by a patient's doctor. Insurers cannot impose arbitrary limits on the number of covered days or apply stricter deductibles/copays for these services than for other covered benefits. The law applies to group/individual health plans but excludes accident-only, dental, vision, Medicare supplements, and certain other limited policies.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for neurorehabilitation services, prevents arbitrary limits on days, and prohibits stricter copays, expanding patient access to necessary brain injury care.95% confidence

Sub-Topics Insurance Medicare

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in committee · Pennsylvania · Senate Apr 11, 2025

SB 608: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, in regulation of insurers and related persons generally, providing for association health plans.

SB 608 creates new rules for "association health plans" in Pennsylvania, which are group health coverage offered by employer associations (like industry groups or local business networks) rather than individual employers. It requires these associations to have existed for at least two years, not deny coverage based on health status, and offer plans to all members regardless of health. The bill defines key terms like "small employer" (1-50 employees) and clarifies that association plans must meet specific policy requirements under state insurance law. This directly affects employer associations and their members (employees of small businesses or sole proprietors) seeking group health coverage through these structures.

Topics ✓ HealthcareSupports HealthcareRequires association health plans to not deny coverage based on health status and offer to all members, protecting patient access and rights.95% confidence

Sub-Topics Insurance

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in committee · Pennsylvania · Senate Jan 22, 2025

SB 52: An Act providing for health care insurance coverage protections, for duties of the Insurance Department and the Insurance Commissioner, for regulations, for enforcement and for penalties.

This bill bans health insurers in Pennsylvania from setting annual or lifetime dollar limits on essential medical services (like hospital care, surgery, and emergency treatment), affecting both in-network and out-of-network providers. It applies to individual and group health insurance policies, directly protecting enrollees from coverage caps on core benefits. Insurers must comply with these limits, with enforcement including fines up to $5,000 per violation. The law takes effect for policies filed with the Insurance Department after its effective date.

Topics ✓ HealthcareSupports HealthcareBans annual/lifetime coverage limits on essential services (hospital, surgery, emergency care), protecting enrollees from caps with enforcement fines.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentBans insurance coverage caps on essential medical services, directly protecting workers' health benefits under employment standards as core employment benefits are covered.95% confidence

Sub-Topics Hospitals Insurance

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in committee · Pennsylvania · House Feb 20, 2025

HB 672: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage of allergenic protein dietary supplements.

HB 672 requires Pennsylvania health insurers to cover prescribed early allergen introduction dietary supplements for infants under one year old, specifically those containing safe, well-cooked egg or peanut protein to help reduce food allergy risk. Insurers must provide this coverage at no additional cost to consumers, including no deductibles, copays, or coinsurance. The law applies to most health insurance policies (excluding specialized plans like dental or workers' compensation) and mandates coverage for supplements prescribed by licensed healthcare providers. It directly affects infants at risk of food allergies, particularly addressing health disparities noted in the bill (e.g., higher allergy rates among Black children). The policy changes are effective 60 days after enactment, with no cost-sharing for these specific supplements.

Topics ✓ HealthcareSupports HealthcareMandates insurer coverage for preventive infant allergy treatment with no cost-sharing, expanding access to healthcare services under insurance coverage.95% confidence

Sub-Topics Insurance

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in committee · Pennsylvania · Senate Jul 23, 2025

SB 959: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in uniform health insurance claim form, further providing for forms for health insurance claims.

SB 959 requires Pennsylvania insurance companies to use a standardized health insurance claim form developed by the Department of Insurance within 180 days. This uniform form must be used by all insurers, the state's public health programs, and healthcare providers within 120 days of its creation, though dental and vision claims may use the form at the insurer's discretion. The bill also mandates that insurers allow direct payment to dental providers when a patient authorizes it (a provision set to expire after 10 years) and requires a study on the impact of this payment rule. The Legislative Budget Committee must report on network participation changes within 36 months of the bill's effective date.

Topics ✓ HealthcareSupports HealthcareStandardizes insurance claims forms and mandates direct dental payments, reducing administrative barriers and improving provider access to reimbursement.85% confidence

Sub-Topics Insurance Public Health

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in committee · Pennsylvania · Senate Feb 20, 2025

SB 268: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for cost-sharing calculation.

SB 268 amends Pennsylvania's Insurance Company Law to establish rules for calculating health insurance cost-sharing. It requires insurers and pharmacy benefits managers (PBMs) to include all out-of-pocket payments made by insured individuals (or others on their behalf) when determining cost-sharing amounts like deductibles or copays. The law applies to health insurance policies issued, renewed, or entered into after its effective date, but excludes dental, vision, workers' compensation, and similar coverage types. This change directly affects health insurers, PBMs, and policyholders by standardizing how cost-sharing is calculated under health plans.

Topics ✓ HealthcareSupports HealthcareRequires insurers to include all out-of-pocket payments in cost-sharing calculations, reducing patient financial burden and protecting patient rights under health insurance.95% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · Pennsylvania · Senate Aug 25, 2025

SB 978: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage of allergenic protein dietary supplements.

SB 978 requires Pennsylvania health insurers to cover early allergen introduction dietary supplements (for peanut or egg protein) prescribed to infants under one year old at no additional cost to the insured. This directly affects infants with food allergy risks and their families covered by health insurance policies, excluding dental, vision, or limited-benefit plans. The law mandates coverage for medically prescribed supplements designed to reduce food allergy development, aligning with clinical guidance for early introduction. It applies to health insurance policies issued or renewed 60 days after the law's effective date.

Topics ✓ HealthcareSupports HealthcareMandates insurer coverage of allergy-prevention supplements for infants, expanding access to preventive healthcare without cost-sharing.95% confidence

Sub-Topics Insurance

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in committee · Pennsylvania · Senate Jul 22, 2025

SB 935: An Act requiring health insurance policies to provide coverage for preexposure prophylaxis HIV medication.

SB 935 (the "PrEP for Pennsylvania Act") mandates that all health insurance policies sold in Pennsylvania must cover the cost of preexposure prophylaxis (PrEP) HIV prevention medication. This directly affects insurance providers, who must include PrEP in standard coverage without moving it to a higher-cost specialty tier, and people who rely on insurance for HIV prevention. The law also prohibits requiring unnecessary specialist counseling to access PrEP. It takes effect 60 days after enactment.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for PrEP HIV prevention without cost-sharing or unnecessary barriers, expanding access to preventive healthcare services.95% confidence

Sub-Topics Insurance

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