Pennsylvania HB 1444: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for association health plans; imposing penalties; and making repeals.

Bill Text

PRINTER'S NO. 1680
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1444
Session of
2025
INTRODUCED BY GAYDOS, KRUPA, KAUFFMAN, OLSOMMER, GROVE,
MUSTELLO, KUZMA, CIRESI, BERNSTINE, BRIGGS, TWARDZIK,
ZIMMERMAN, ROWE AND KOZAK, MAY 12, 2025
REFERRED TO COMMITTEE ON INSURANCE, MAY 12, 2025
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for association health plans; imposing
penalties; and making repeals.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 41
ASSOCIATION HEALTH PLANS
Sec.
4101. Definitions.
4102. Association requirements.
4103. Association health plan coverage requirements.
4104. Association health plan rate and premium requirements.
4105. Health insurer association health plan filing
requirements.
4106. Regulations.
4107. Enforcement.
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§ 4101. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Affordable Care Act." The Patient Protection and Affordable
Care Act (Public Law 111-148, 124 Stat. 119), together with the
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152, 124 Stat. 1029), as amended.
"A ssociation." As follows:
(1) A member-based organization of employer members
composed of:
(i) Employers in the same industry, trade or
profession.
(ii ) Employers that do not share the same industry,
trade or profession to the extent permitted under
regulations of the United States Department of Labor in
relation to ERISA.
(iii) Employers domiciled or residing in this
Commonwealth.
(2) The term does not include a union trust established
under a collective bargaining agreement that makes available
health care coverage to the union trust's members.
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Covered individual." As follows:
(1) An individual on whose behalf a health insurer is
obligated to pay covered health care expense benefits or
provide health care services under a health insurance policy.
( 2) The term includes a policyholder, certificate
holder, subscriber, member, dependent or other individual who
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is eligible to receive health care services under a health
insurance policy.
"Employee." As follows:
(1) An individual employed by an employer.
(2) The term includes a sole proprietor to the extent
permitted under regulations of the United States Department
of Labor in relation to ERISA.
"Employer." As follows:
(1) As defined in section 29 U.S.C. § 1002(5) (relating
to definitions).
(2) The term includes a sole proprietor to the extent
permitted under regulations of the United States Department
of Labor in relation to ERISA.
"Employer member." An employer that is a member of an
association.
"ERISA." 29 U.S.C. Ch. 18 (relating to employee retirement
income security program).
"Health care service." A covered treatment, admission,
procedure, medical supply or equipment or other service,
including behavioral health, prescribed or otherwise provided or
proposed to be provided by a health care provider to a covered
individual under a health insurance policy.
"Health factor." An element related to an individual's
physical or mental make-up, including:
(1) Health status.
(2) M edical condition.
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
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(7) Evidence of insurability, including conditions
arising out of acts of domestic violence.
(8) Disability.
"Health insurance policy." As follows:
(1) An insurance policy, subscriber contract,
certificate or plan issued by a health insurer that provides
medical or health care coverage, including emergency
services.
( 2) The term does not include any of the following:
(i) An accident only policy.
( ii) A credit only policy.
(iii) A long-term care or disability income policy.
(iv) A specified disease policy.
(v) A Medicare supplement policy.
(vi) A TRICARE policy, including a Civilian Health
and Medical Program of the Uniformed Services (CHAMPUS)
supplement policy.
(vii) A fixed indemnity policy.
(viii) A hospital indemnity policy.
(ix) A dental only policy.
(x) A vision only policy.
(xi) A workers' compensation policy.
(xii) An automobile medical payment policy.
(xiii) A homeowners insurance policy.
(xiv) A short-term limited duration policy.
(xv) Any other similar policy providing for limited
benefits.
"Health insurer." An entity licensed by the department with
accident and health authority to issue a health insurance policy
that is offered or governed under any of the following:
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