Pennsylvania HB 755: An Act providing for health care insurance preventive services coverage protections; conferring authority on the Insurance Department and the Insurance Commissioner; and providing for regulations, for enforcement and for penalties.

Bill Text

PRINTER'S NO. 779
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 755
Session of
2025
INTRODUCED BY WARREN, PIELLI, VENKAT, OTTEN, SANCHEZ, KHAN,
PROKOPIAK, GIRAL, FREEMAN, HANBIDGE, HOHENSTEIN, DONAHUE,
GALLAGHER, SCHLOSSBERG, HOWARD, SHUSTERMAN, DALEY, DEASY,
FIEDLER, MADDEN AND MALAGARI, MARCH 3, 2025
REFERRED TO COMMITTEE ON INSURANCE, MARCH 3, 2025
AN ACT
Providing for health care insurance preventive services coverage
protections; conferring authority on the Insurance Department
and the Insurance Commissioner; and providing for
regulations, for enforcement and for penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Health
Insurance Preventive Services Coverage Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Cost sharing." The share of health care costs covered by an
insurance policy that an enrollee pays out-of-pocket. The term
includes deductibles, coinsurance, copayments and similar
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charges. The term does not include a premium, a balance billed
amount from an out-of-network provider or the cost of a
noncovered service.
"Department." The Insurance Department of the Commonwealth.
"Enrollee." A policyholder, subscriber, covered person or
other individual who is entitled to receive health care services
under a health insurance policy.
"Grandfathered health care plan." Individual or group health
insurance coverage in which an individual was enrolled prior to
March 23, 2010, or as specified in 42 U.S.C. § 18011 (relating
to preservation of right to maintain existing coverage).
"Health insurance policy." A policy, subscriber contract,
certificate or plan issued by an insurer that provides medical
or health care coverage. The term does not include any of the
following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A fixed indemnity policy.
(7) A dental only policy.
(8) A vision only policy.
(9) A workers' compensation policy.
(10) An automobile medical payment policy.
(11) A policy under which benefits are provided by the
Federal Government to active or former military personnel and
their dependents.
(12) A hospital indemnity policy.
(13) Any other similar policy providing for limited
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benefits.
"Insurer." An entity that offers, issues or renews a health
insurance policy that provides medical or health care coverage
by a health care facility or licensed health care provider and
that is governed under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Out-of-network provider." A provider who does not contract
with an insurer to provide health care services to an enrollee
under a health insurance policy.
"Preventive service." A health care service that is on the
preventive services list.
"Preventive services list." A list of health care services
compiled by the department that includes:
(1) Health care services required to be covered by an
individual health insurance policy approved to be offered or
issued in this Commonwealth on January 1, 2025, as a
preventive service in accordance with 42 U.S.C. § 300gg-13
(relating to coverage of preventive health services), other
than any health care service exempted by the department under
the modification process under section 4.
(2) Health care services added by the department under
the modification process under section 4.
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Section 3. Preventive services coverage requirement.
An insurer offering, issuing or renewing a health insurance
policy other than a grandfathered health care plan shall provide
coverage and may not impose any cost-sharing requirements for
services on the preventive services list.
Section 4. Modification of preventive services list.
(a) Additions and exemptions.--The department may add or
exempt one or more preventive services from the preventive
services list in accordance with the requirements of this
section.
(b) Notice and comment requirements.--Prior to adopting an
addition to or exemption from the preventive services list, the
department shall:
(1) Transmit a notice to the Legislative Refere