Pennsylvania HB 1863: An Act establishing the Public Option Program and the Public Option Program Fund; and imposing duties on the Insurance Department.

Bill Text

PRINTER'S NO. 2312
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1863
Session of
2025
INTRODUCED BY WAXMAN, HILL-EVANS, GIRAL, MAYES, FREEMAN, CEPEDA-
FREYTIZ, STEELE, SANCHEZ, FRANKEL AND SCOTT,
SEPTEMBER 15, 2025
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 16, 2025
AN ACT
Establishing the Public Option Program and the Public Option
Program Fund; and imposing duties on the Insurance
Department.
TABLE OF CONTENTS
Chapter 1. Preliminary Provisions
Section 101. Short title.
Section 102. Definitions.
Chapter 3. Public Option Program
Section 301. Establishment of program.
Section 302. Operation of program.
Section 303. Contracts.
Section 304. Qualified health insurance policies.
Section 305. Enrollment.
Section 306. Eligibility.
Section 307. Coverage requirements.
Section 308. Reimbursement rates.
Section 309. Premiums.
Chapter 5. Public Option Program Fund
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Section 501. Establishment of fund.
Section 502. Administration and purposes.
Section 503. Appropriation on continuing basis.
Section 504. Fund sources.
Section 505. Money to remain in fund.
Chapter 7. Miscellaneous Provisions
Section 701. Reports.
Section 702. Effective date.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
CHAPTER 1
PRELIMINARY PROVISIONS
Section 101. Short title.
This act shall be known and may be cited as the Public Option
Program Act.
Section 102. 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:
"Covered person." A policyholder, subscriber or other
individual who is entitled to receive health care services under
a health insurance policy.
"Department." The Insurance Department of the Commonwealth.
"Facility." A health care setting or institution providing
health care services, including:
(1) A general, special, psychiatric or rehabilitation
hospital.
(2) An ambulatory surgical facility.
(3) A cancer treatment center.
(4) A birth center.
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(5) A skilled nursing center.
(6) An inpatient, outpatient or residential drug and
alcohol treatment facility.
(7) A facility licensed by the Office of Mental Health
and Substance Abuse Services of the Department of Human
Services.
(8) A laboratory, imaging, diagnostic or other
outpatient medical service or testing facility.
(9) A health care provider office or clinic.
"Fund." The Public Option Program Fund established under
section 501.
"Health care practitioner." As follows:
(1) A licensed hospital or health care facility, medical
equipment supplier or person who is licensed, certified or
otherwise regulated to provide health care services under the
laws of this Commonwealth, including a physician, podiatrist,
optometrist, psychologist, physical therapist, certified
nurse practitioner, registered nurse, nurse midwife,
physician's assistant, chiropractor, dentist, pharmacist or
an individual accredited or certified to provide behavioral
health services.
(2) The term includes an individual providing emergency
services under a licensed emergency medical services agency
as defined in 35 Pa.C.S. § 8103 (relating to definitions).
"Health care service." Any covered treatment, admission,
procedure, medical supplies and equipment or other services,
including behavioral health, prescribed or otherwise provided or
proposed to be provided by a health care provider to a covered
person for the diagnosis, prevention, treatment, cure or relief
of a health condition, illness, injury or disease under the
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terms of a health insurance policy.
"Health insurance policy." As follows:
(1) A policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage.
(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 under 75
Pa.C.S. (relating to vehicles).
(xiii) A homeowner's insurance policy.
(xiv) Any other similar policies providing for
limited benefits.
"Individual market." The market for health insurance
coverage offered to individuals other than in connection with a
group.
"Insurer." An entity licensed by the department that offers,
issues or renews an individual or group health insurance policy
that is offered or governed under any of the following:
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