Pennsylvania HB 1828: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for immunization coverage; and imposing penalties.

Bill Text

PRIOR PRINTER'S NO. 2247 PRINTER'S NO. 2415
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1828
Session of
2025
INTRODUCED BY VENKAT, KHAN, KOSIEROWSKI, McNEILL, PROBST,
T. DAVIS, HILL-EVANS, PIELLI, SCHLOSSBERG, HOWARD, RIVERA,
INGLIS, SANCHEZ, SAPPEY, HOHENSTEIN, D. WILLIAMS, WAXMAN,
SIEGEL, MAYES, BELLMON, FRANKEL, STEELE, ISAACSON,
SHUSTERMAN, BOYD, HADDOCK, HANBIDGE, BOROWSKI, MUNROE,
SALISBURY, OTTEN, MERSKI, KINKEAD, GREEN AND SCOTT,
AUGUST 28, 2025
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, OCTOBER 7, 2025
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for immunization coverage; and imposing
penalties.
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 52
IMMUNIZATION COVERAGE
Sec.
5201. Scope of chapter.
5202. Definitions.
5203. Immunization coverage requirement.
5204. Additions and exceptions.
5205. Construction.
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5206. Regulations.
5207. Enforcement.
§ 5201. Scope of chapter.
This chapter relates to immunization coverage.
§ 5202. 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:
"Advisory Committee on Immunization Practices." The Advisory
Committee on Immunization Practices of the Centers for Disease
Control and Prevention.
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Cost-sharing." The share of health care costs covered by a
health insurance policy that an enrollee pays out-of-pocket. The
term includes deductibles, coinsurance, copayments and similar
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.
"Enrollee." The term shall mean the same as defined under
section 9103 (relating to definitions).
"Grandfathered health care plan." The term shall mean the
same as defined under section 9103.
"Health care provider." A person who is licensed, certified
or otherwise regulated to provide health care services under the
laws of this Commonwealth.
"Health insurance policy." The term shall mean the same as
defined under section 9103.
"Immunization." A vaccine or other immunizing agent. The
term includes vaccines or other immunizing agents required to be
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covered by an individual health insurance policy approved to be
offered or issued in this Commonwealth on January 1, 2025.
"Insurer." The term shall mean the same as defined under
section 9103.
"Out-of-network provider." A health care provider who does
not contract with an insurer to provide health care services to
an enrollee under a health insurance policy.
§ 5203. Immunization 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 an immunization to an enrollee. THE
REQUIREMENTS OF THIS SECTION SHALL NOT APPLY TO A GRANDFATHERED
HEALTH CARE PLAN.
§ 5204. Additions and exceptions.
(a) Authority of department.--The department may , IN
CONSULTATION WITH THE DEPARTMENT OF HEALTH, add or except an
immunization from the coverage requirement if the Department of
Health makes a determination consistent with the requirements of
this section.
(b) Additions to coverage requirement.--The department may
add an immunization to the coverage requirement and establish
the manner and frequency of the administration in consultation
with the Department of Health, following BASED ON a
determination by the Department of Health in accordance with the
following:
(1) One of the following:
(i) the immunization is recommended by the Advisory
Committee on Immunization Practices; or
(ii) both of the following are met:
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(A) Immunization of certain populations is
supported by medical evidence.
(B) Immunization of certain populations would
advance the public health by reducing the spread or
severity of infectious diseases in this Commonwealth.
(2) In making a determination under paragraph (1)(ii),
the Department of Health may consider a report from any of
the following entities as evidence to support a
determination:
(i) The American Academy of Pediatrics.
(ii) The American College of Obstetricians and
Gynecologists.
(iii) The American College of Physicians.
(iv) The American Academy of Family Physicians.
(v) The Infectious Diseases Society of America.
(vi) The Society for Maternal-Fetal Medicine.
(c) Exceptions from coverage requirement.--
(1) The department may except an immunization from the
coverage requirement follow