Pennsylvania SB 50: 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.

Bill Text

PRINTER'S NO. 97
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 50
Session of
2025
INTRODUCED BY HUGHES, COLLETT, BOSCOLA, CAPPELLETTI, COMITTA,
COSTA, FLYNN, FONTANA, HAYWOOD, KANE, KEARNEY, KIM, MILLER,
MUTH, PISCIOTTANO, SANTARSIERO, SAVAL, SCHWANK, STREET,
TARTAGLIONE, A. WILLIAMS AND L. WILLIAMS, JANUARY 22, 2025
REFERRED TO BANKING AND INSURANCE, JANUARY 22, 2025
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.
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 Access Protection 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:
"Affordable Care Act." Collectively, the Patient Protection
and Affordable Care Act (Public Law 111-148, 124 Stat. 119) and
the Health Care and Education Reconciliation Act of 2010 (Public
Law 111-152, 124 Stat. 1029).
"Commissioner." The Insurance Commissioner of the
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Commonwealth.
"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 plan." Individual or group health
insurance coverage in which an individual was enrolled prior to
the date of enactment of the Affordable Care Act or as otherwise
specified in 42 U.S.C. § 18011 (relating to preservation of
right to maintain existing coverage).
"Group health insurance policy." A policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to
individuals who obtain health insurance coverage through a
group.
"Health factor." An element related to an individual's
physical or mental makeup, including:
(1) Health status.
(2) Medical condition.
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability, including conditions
arising out of acts of domestic violence.
(8) Disability.
"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:
20250SB0050PN0097 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

(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) Any other similar policies providing for limited
benefits.
"Individual health insurance policy." A policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to an
individual other than in connection with a group.
"Individual market." The market for health insurance
coverage offered to individuals other than in connection with a
group.
"Insurer." An entity that offers, issues or renews an
individual health insurance policy or group 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.
20250SB0050PN0097 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

(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).
"Pre-existing condition." A health condition present before
the date of enrollment for coverage, or, if coverage is denied,
the date of the denial, whether or not any medical advice,
diagnosis, care or treatment was recommended or received before
that date.
"Small group market." The market for health insurance for
coverage offered through a group health insurance policy for a
group of 2 to 50 individuals, exclusive of their dependents.
"Wellness program." A program offered by an employer that is
designed to promote health or prevent disease.
Section 3. Prohibitions concerning discrimination based on pre-
existing conditions or health factors.
(a) Prohibition concerning eligibility