Healthcare (Insurance)

in committee · Pennsylvania · Senate Jul 22, 2025

SB 935: An Act requiring health insurance policies to provide coverage for preexposure prophylaxis HIV medication.

SB 935 (the "PrEP for Pennsylvania Act") mandates that all health insurance policies sold in Pennsylvania must cover the cost of preexposure prophylaxis (PrEP) HIV prevention medication. This directly affects insurance providers, who must include PrEP in standard coverage without moving it to a higher-cost specialty tier, and people who rely on insurance for HIV prevention. The law also prohibits requiring unnecessary specialist counseling to access PrEP. It takes effect 60 days after enactment.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for PrEP HIV prevention without cost-sharing or unnecessary barriers, expanding access to preventive healthcare services.95% confidence

Sub-Topics Insurance

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in committee · Pennsylvania · House Feb 21, 2025

HB 695: An Act providing for vaccination schedule for pediatric patients and for coverage, compensation and reimbursement for vaccinations; and imposing penalties.

HB 695 requires health insurance plans to cover vaccinations administered on schedules chosen by parents or guardians that differ from CDC recommendations, provided at least one vaccine is given annually. It prohibits insurers from offering financial incentives to providers based on per-member vaccination rates. Health care practitioners must continue providing pediatric care for patients on non-CDC schedules and cannot bill for discussions about alternative schedules. Violations by practitioners could result in disciplinary action from their licensing board.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for non-CDC vaccination schedules, expands patient choice, prohibits financial incentives limiting provider options, and protects access to pediatric care on alternative schedules.95% confidence

Sub-Topics Children's Health Insurance Medical Licensing

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in committee · Pennsylvania · Senate Sep 4, 2025

SB 989: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for immunization coverage; and imposing penalties.

SB 989 would require health insurance plans in Pennsylvania to cover immunizations (such as vaccines) without out-of-pocket costs for policyholders. The bill applies to all health insurance providers operating in the state and mandates that they include immunization coverage in their plans. It also imposes penalties on insurers that fail to provide this coverage. This change would directly affect insurance companies and ensure Pennsylvanians with health insurance have guaranteed access to immunization services.

Topics ✓ HealthcareSupports HealthcareMandates no-cost vaccine coverage in insurance plans, removing financial barriers and expanding access to preventive healthcare services.95% confidence

Sub-Topics Insurance

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in committee · Pennsylvania · House Oct 29, 2025

HB 305: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for insulin.

HB 305 requires health insurance policies to cover insulin, directly affecting people with diabetes who rely on this medication. It amends the 1921 Insurance Company Law to mandate that casualty insurance plans include insulin coverage without excessive cost-sharing. The key provision eliminates gaps where insulin might previously have been excluded or subject to high out-of-pocket costs. This policy change applies to all insurers offering casualty coverage under the amended law. The bill is currently pending before the Insurance committee.

Topics ✓ HealthcareSupports HealthcareMandates insulin coverage in insurance policies, eliminating cost barriers for diabetes patients, directly expanding essential medication access under healthcare coverage.95% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · Pennsylvania · House Mar 17, 2025

HR 124: A Resolution designating the month of September 2025 as "Prostate Cancer Awareness Month" in Pennsylvania.

This resolution designates September 2025 as "Prostate Cancer Awareness Month" in Pennsylvania. It symbolically raises public attention to prostate cancer, highlighting statistics like an estimated 13,000 new cases and 1,500 deaths in Pennsylvania during 2025. The resolution also urges Congress to support federal legislation (H.R. 1300) that would require health insurance coverage for prostate cancer screenings without cost-sharing for at-risk men. It does not create new laws or funding but aims to promote awareness and encourage preventive care.

Topics ✓ HealthcareSupports HealthcareUrges support for H.R. 1300 requiring insurance coverage of prostate cancer screenings without cost-sharing, expanding patient access to preventive care.92% confidence

Sub-Topics Insurance Primary Care

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in committee · Pennsylvania · House May 5, 2025

HB 1391: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for reimbursement for custom-fabricated devices, custom-fitted devices, orthosis, orthotics, over-the-counter prostheses, orthoses and pedorthic devices, prefabricated orthoses, prostheses, prosthetics and components of such devices.

House Bill 1391 amends The Insurance Company Law of 1921 to mandate that individual and group health insurance policies provide coverage for various custom-fabricated, custom-fitted, orthotic, prosthetic, and pedorthic devices. This applies when these devices are prescribed by an authorized medical professional, directly affecting individuals who require such medical aids and the health insurance companies providing their coverage. The bill requires coverage for the fitting, repair, or replacement of these devices, including those used for recreational, organized, or adaptive sports, and allows insurers to require preauthorization while applying standard cost-sharing. Additionally, Medicaid and contracted insurers would reimburse for these devices at Federal Medicare rates.

Topics ✓ HealthcareSupports HealthcareMandates health insurance coverage for prescribed medical devices, expanding patient access to essential orthotics/prosthetics under healthcare policy.95% confidence

Sub-Topics Insurance Medicaid Medicare

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in committee · Pennsylvania · House Mar 19, 2025

HB 966: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for departmental powers and duties and providing for additional penalties.

HB 966 amends Pennsylvania's Insurance Company Law of 1921 to strengthen consumer protections in health insurance. It requires insurance companies to pay penalties if over 50% of their denied health claims (excluding administrative denials) are later overturned through internal or external review processes. Penalties start at $50,000 for the first overturned claim and increase to $250,000 per claim for subsequent violations. Collected penalties must fund consumer protection activities, in addition to any other existing penalties. This directly affects health insurers operating in Pennsylvania.

Topics ✓ HealthcareSupports HealthcareStrengthens consumer protections in health insurance by penalizing insurers for unjust claim denials, funding consumer protection activities per bill summary.95% confidence

Sub-Topics Insurance

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in committee · Pennsylvania · House Apr 4, 2025

HB 1152: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, further providing for billing.

HB 1152 requires insurance companies to directly reimburse non-network emergency medical services (EMS) agencies for 911 emergency calls within 45 days at 350% of the Medicare ambulance rate for the same service in the same area. EMS agencies must register with the state annually to qualify for direct payments, and insurers cannot demand contracts to facilitate this reimbursement. The insurer's payment covers the full service cost (excluding the patient's copay, coinsurance, or deductible), so EMS agencies cannot bill patients for the remaining amount. This law applies only to non-network EMS providers offering 911 emergency medical services, unless preempted by federal law.

Topics ✓ HealthcareSupports HealthcareMandates insurers to reimburse non-network EMS at 350% of Medicare rate within 45 days, ensuring emergency service coverage without patient cost shifting, strengthening access to critical healthcare services.95% confidence

Sub-Topics Insurance Medicare

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passed · Pennsylvania · House Mar 25, 2025

HB 755: An Act providing for health care insurance preventive services coverage protections; conferring authority on the Insurance Department and the Insurance Commissioner; and providing for regulations, for enforcement and for penalties.

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.

Topics ✓ HealthcareSupports HealthcareMandates insurers to cover preventive services without cost-sharing, expanding access to vaccinations and screenings at no extra cost.95% confidence

Sub-Topics Insurance Primary Care

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in committee · Pennsylvania · House Apr 9, 2025

HB 1184: An Act imposing a moratorium on enactment of new or expanded health insurance policy mandated benefits; and requiring the Legislative Budget and Finance Committee to study the issue of health insurance mandates and report to the General Assembly.

HB 1184 imposes a temporary pause on new or expanded health insurance coverage requirements (mandated benefits) in Pennsylvania. It directly affects insurers and employers who would otherwise be required to cover new treatments, equipment, or provider-specific services under health insurance policies. The bill requires the Legislative Budget and Finance Committee to study existing state-mandated health benefits by December 2026, analyzing their costs, fiscal impact, and effectiveness. The study must also determine if current mandates trigger federal payment obligations. The moratorium takes effect immediately and remains in place until the committee submits its report.

Topics ✗ Budget & TaxesOpposes Budget & TaxesMoratorium on new health insurance mandates prevents future state-mandated costs, restricting fiscal obligations and aligning with budget restraint.85% confidence ✗ HealthcareOpposes HealthcareBill imposes moratorium on new health insurance mandated benefits, restricting expansion of required coverage and limiting patient access to new treatments/services.95% confidence ✗ Labor & EmploymentOpposes Labor & EmploymentBill halts new health insurance mandates, preventing expanded worker benefits required of employers, restricting additional coverage under employment standards.90% confidence

Sub-Topics Insurance

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