SB 50, the Health Insurance Access Protection Act, prohibits Pennsylvania insurers from denying coverage, charging higher premiums, or excluding benefits based on pre-existing conditions or health factors for individuals and small groups (2-50 people). It limits premium variations to age (max 3:1 ratio), location, family size, and tobacco use (max 1.5:1 ratio), requiring insurers to pool all enrollees in the individual and small group markets. The law also mandates that insurers cannot use health status to set rates or deny coverage, directly protecting people with chronic illnesses or past medical issues.
SB 95 amends Pennsylvania's Pharmacy Act to create a 180-day provisional license for pharmacists moving from other states, allowing them to practice without demonstrating competency under Pennsylvania's requirements. It also permits emergency medical services providers to distribute naloxone dose packages for opioid overdose reversal under specific conditions, including a Department of Health standing order and voluntary distribution without liability. Additionally, the bill requires pharmacies to disclose prescription drug prices (brand vs. generic), cost-sharing amounts, and health insurance options upon customer request. These changes aim to improve pharmacist mobility, expand naloxone access, and increase price transparency for consumers.
SB 447 requires health insurance policies in Pennsylvania to cover annual prostate cancer screenings with no out-of-pocket costs for men aged 40+ who are high-risk. High-risk status includes genetic factors, family history of prostate cancer (a first-degree relative diagnosed), or physician determination of medical need. The law mandates coverage for screenings like PSA tests and digital rectal exams, applying to policies filed or renewed 180 days after the law takes effect. It directly affects insured men meeting these criteria and insurance companies offering health coverage in Pennsylvania.
HB 565 creates a new tax credit for Pennsylvania employers who pay for their employees' health insurance. It allows businesses to reduce their state tax bill by up to 100% of their contributions toward employee health insurance premiums, but only the first $500 per employee counts toward the credit. The credit percentage decreases as the number of covered employees increases: 100% for fewer than 50 employees, 75% for 50-99 employees, and 50% for 100+ employees. Employers must submit specific employee and insurance provider details to the Department of Revenue to claim the credit, which cannot be carried over, refunded, or sold.
SB 301 requires Pennsylvania pharmacies to disclose specific pricing information to consumers upon request for prescription medications. This includes the current retail price for brand-name and generic drugs, the consumer's cost-sharing amount under their insurance, and details about subsidized health coverage through Pennsylvania's health insurance exchange. Pharmacies must keep records of this information, post clear notices about the disclosure right, and present details in simple terms. Failure to comply results in a $500 fine per violation. The law applies to all retail pharmacies and directly affects consumers making prescription purchasing decisions.
HB 2041 amends Pennsylvania's Childhood Blood Lead Test Act to require health care practitioners to ensure children receive at least one blood lead test by 12 months of age and a second test by 24 months of age, with additional testing mandated between 24 and 72 months if not tested by age 2. The bill also requires blood lead testing for pregnant women who have at least one identified lead exposure risk factor. It clarifies that health insurance must cover these tests without cost-sharing, as defined in the bill. This law directly affects children under 72 months, pregnant women, and health care providers in Pennsylvania.
This bill, the Health Care Practitioner Credentialing Act, requires Pennsylvania health insurers to accept the CAQH credentialing application or a nationally recognized alternative for health care practitioners seeking to join provider networks. It sets clear timelines: insurers must notify practitioners within 10 business days if an application is incomplete and issue a credentialing decision within 45 business days for complete applications. Insurers failing to comply may face administrative penalties, though the bill does not guarantee practitioners a spot in any insurer's network. The law applies broadly to most health insurers (including Medicaid managed care organizations) but excludes certain coverage types like accident-only or vision insurance.
HB 1965 establishes a certification process for community paramedicine providers in Pennsylvania, requiring them to meet state standards to deliver certain medical services. It mandates that casualty insurance carriers cover community paramedicine services in their policies and requires state medical assistance programs to reimburse providers for these services. The bill directly affects community paramedicine providers (who must certify), insurance companies (who must provide coverage), and state health programs (which must pay for covered services). These changes aim to formalize and expand access to community-based emergency medical care through standardized provider qualifications and insurance coverage.
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 1527 updates the existing Rare Disease Advisory Council established in 2017, clarifying its structure and responsibilities. The bill directly affects patients with rare diseases and requires coordination among the Department of Health, Insurance Department, Department of Human Services, and Department of Education. Key provisions mandate the council to advise state agencies on rare disease research, treatment access, insurance coverage, and resource allocation. It also specifies how departments must collaborate on policies impacting rare disease patients, ensuring a unified state approach.
