HB 1100 amends Pennsylvania's Human Services Code to allow public assistance recipients to use their benefits to purchase diapers and menstrual hygiene products through a new waiver program. This directly affects low-income individuals and families enrolled in public assistance programs who currently cannot use their benefits for these essential items. The key provision adds diapers and menstrual hygiene products to the list of eligible purchases under an administrative waiver, changing the existing code to expand access to basic necessities. The bill does not change benefit amounts or eligibility criteria but creates a new pathway for purchasing specific hygiene products. It passed the legislature in June 2025 and was referred to the Health & Human Services committee for implementation.
This bill modifies Pennsylvania's Human Services Code to change how medical providers are reimbursed for specific services provided to public assistance recipients. It updates reimbursement rules for certain medical items and services while replacing outdated regulations that conflicted with these changes. The primary effect is on healthcare providers who bill state assistance programs, streamlining the process for claiming payments. The bill does not create new benefits but adjusts existing reimbursement procedures under public assistance programs.
HB 1445 requires health insurers in Pennsylvania to cover medically necessary health services provided in schools - such as mental health care, behavioral health services, and speech therapy - without denying coverage solely because the service occurs in a school setting. It prohibits insurers from excluding coverage based on location (e.g., through "school setting" or "place of service" exclusions), applying to public, charter, cyber charter, and private schools. Exceptions allow denials if services are provided by unlicensed individuals, are not medically necessary per insurer policies, or conflict with existing legal obligations (like IEPs). This law directly affects students receiving school-based care, insurers, and school entities, ensuring coverage parity for services delivered on school premises.
HB 1088 amends Pennsylvania's 1921 Insurance Company Law to require casualty insurance policies to cover blood pressure monitors. This directly affects policyholders who rely on these devices for managing health conditions like hypertension, ensuring they are not excluded from standard coverage. The bill adds a specific provision mandating insurers to include blood pressure monitors as covered items under casualty insurance policies. It changes insurer obligations without altering broader policy terms, focusing on making a common medical device accessible through existing insurance frameworks.
HB 1140 requires health insurers and Medicaid/CHIP managed care plans in Pennsylvania to cover all FDA-approved contraceptives - including prescription drugs, devices, emergency contraception (like levonorgestrel), and oral contraceptives - without any out-of-pocket costs for enrollees. It specifically prohibits prior authorization or step therapy for emergency and oral contraceptives, and mandates coverage for sterilization procedures and related services like counseling. The bill directly affects health insurers, managed care plans, and their enrollees by expanding contraceptive coverage under state insurance regulations. It exempts male condoms from coverage requirements but ensures no cost-sharing for covered contraceptive methods.
HB 433 requires health insurance plans to cover mammograms and breast imaging services without cost-sharing (like copays or deductibles) for policyholders. It directly affects women needing preventive breast cancer screenings and the insurance companies providing health coverage. The bill amends Pennsylvania’s 1921 Insurance Company Law to mandate this coverage for mammographic examinations and breast imaging under casualty insurance policies. This policy change ensures these essential preventive services are fully covered at no additional cost to patients.
HB 535 bans Pennsylvania health insurers from setting annual or lifetime dollar limits on core health benefits for enrollees, whether services are provided by in-network or out-of-network providers. It applies to all individual and group health insurance policies (excluding specific types like Medicare supplements or dental/vision-only plans) and prohibits limits on benefits that were already covered without such caps in 2025 policies. The Insurance Department can enforce this through fines up to $5,000 per violation (or $10,000 for willful violations), with annual caps of $500,000 for insurers. The law does not require coverage of specific benefits but eliminates existing dollar limit practices for covered services.
HB 618, the Health Insurance Access Protection Act, prohibits health insurers from denying coverage or charging higher premiums based on a person's health condition, including preexisting conditions. This law applies to both individual and group health insurance policies, protecting enrollees and their dependents from discrimination in enrollment or pricing. The Insurance Department and Commissioner are tasked with enforcing these rules, and the bill includes penalties for insurers that violate the prohibitions.
HB 755 requires health insurers in Pennsylvania (excluding grandfathered plans) to cover all preventive health services listed by the Insurance Department without cost-sharing, such as copays or deductibles. This directly affects insurers who must comply with the coverage rules and enrollees who gain access to preventive care like vaccinations and screenings at no extra cost. The bill empowers the Insurance Department to create and update the preventive services list through a public comment process (15+ business days) and enforce compliance with penalties for violations. It aligns with federal preventive care standards but allows Pennsylvania to adjust the list based on public input and evidence-based guidelines.
HB 404 amends Pennsylvania's Insurance Company Law to extend health insurance coverage for children under family policies. It requires policies to cover dependent children up to age 26 (previously 19) and prohibits insurers from denying or restricting coverage based on a child's financial dependency, residency, marital status, school enrollment, or employment. The bill also allows group health plans to extend coverage for adult children up to age 29 if they meet specific conditions, such as not being married, having no dependents, and residing in Pennsylvania or attending school full-time. This affects all health insurance policies sold in Pennsylvania that provide dependent child coverage.
