PRINTER'S NO. 1064
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1050
Session of
2023
INTRODUCED BY BOYLE, MADDEN, VENKAT, KHAN, HOHENSTEIN, WAXMAN,
SANCHEZ, BOROWSKI, PARKER, HILL-EVANS, KRAJEWSKI, KINSEY,
YOUNG, STURLA, SHUSTERMAN, HOWARD AND WARREN, APRIL 28, 2023
REFERRED TO COMMITTEE ON INSURANCE, APRIL 28, 2023
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.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Health
Insurance Preventive Services Coverage Act.
Section 2. 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:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Cost sharing." The share of health care costs covered by an
insurance policy that an enrollee pays out-of-pocket. The term
includes deductibles, coinsurance, copayments and similar
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charges. The term does not include premium, a balance billed
amount from an out-of-network provider or the cost of a
noncovered service.
"Department." The Insurance Department of the Commonwealth.
"Enrollee." A policyholder, subscriber, covered person or
other individual who is entitled to receive health care services
under a health insurance policy.
"Group health insurance policy." A policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to
individuals who obtain health insurance coverage through a
group.
"Health insurance policy." A policy, subscriber contract,
certificate or plan issued by an insurer that provides medical
or health care coverage. The term does not include any of the
following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A fixed indemnity policy.
(7) A dental only policy.
(8) A vision only policy.
(9) A workers' compensation policy.
(10) An automobile medical payment policy.
(11) A policy under which benefits are provided by the
Federal Government to active or former military personnel and
their dependents.
(12) A hospital indemnity policy.
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(13) Any other similar policy providing for limited
benefits.
"Individual health insurance policy." A policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to an
individual other than in connection with a group.
"Insurer." An entity that offers, issues or renews an
individual or group health insurance policy that provides
medical or health care coverage by a health care facility or
licensed health care provider and that is governed under any of
the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV of The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Out-of-network provider." A provider who does not contract
with an insurer to provide health care services to an enrollee
under a health insurance policy.
Section 3. Preventive services coverage.
(a) Requirements.--An insurer offering, issuing or renewing
an individual health insurance policy or group health insurance
policy shall, at a minimum, provide coverage and not impose any
cost-sharing requirements for preventive services at least as
comprehensive in scope as the preventive services required to be
provided in an individual health insurance policy or group
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health insurance policy first offered or issued in this
Commonwealth in 2022.
(b) Modification of preventive services.--The department may
promulgate regulations to add or exempt one or more services
from the services required to be covered without cost sharing
under this section. In considering an addition or exemption, the
department will take into account the following:
(1) The health care needs of diverse segments of the
population, including women, children, persons with
disabilities and other groups.
(2) The accessibility, including cost, of preventive
services.
(3) Changes in medical evidence or scientific
advancement, including those identified as:
(i) Evidence-based items or services that have in
effect a rating of "A" or "B" by the United States
Preventive Services Task Force.
(ii) Recommended immunizations by the Advisory
Committee on Immunization Practices of the Centers for
Disease Control and Prevention.
(iii) Evidence-informed preventive care and
screenings provided for in the comprehensive guidelines
supported by the Health Resources and Services
Administration.
(4) The potential for discrimination against individuals
because of their age or expected length of life, present or
predicted disability, degree of medical dependency, quality
of life or other health conditions.
(c) Construction.--Nothing in this section shall be
construed:
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(1) To prohibit an insurer from providing coverage for
preventive services in addition to those designated under
this act.
(2) To prohibit an insurer to deny coverage for
preventive services not designated under this act.
(3) To prevent an insurer from utilizing value-based
insurance designs.
(4) To diminish any other law that limits cost sharing
for a health care service.
Section 4. Regulations.
(a) Authority to promulgate.--The department may promulgate
regulations as may be necessary and appropriate to carry out the
provisions of this act.
(b) Temporary regulations.--
(1) Notwithstanding any other provision of law, in order
to facilitate the prompt implementation of this act, the
department may issue temporary regulations which shall expire
no later than two years following publication of the
temporary regulations in the Pennsylvania Bulletin. The
temporary regulations shall be exempt from the following:
(i) Section 612 of the act of April 9, 1929
(P.L.177, No.175), known as The Administrative Code of
1929.
(ii) Sections 201, 202, 203, 204 and 205 of the act
of July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(iii) Sections 204(b) and 301(10) of the act of
October 15, 1980 (P.L.950, No.164), known as the
Commonwealth Attorneys Act.
(iv) The act of June 25, 1982 (P.L.633, No.181),
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known as the Regulatory Review Act.
(2) The authority of the department to issue temporary
regulations under this subsection shall expire two years from
the effective date of this subsection. Regulations adopted
after the two-year period shall be promulgated as provided by
statute.
Section 5. Enforcement.
(a) General rule.--Upon satisfactory evidence of the
violation of any section of this act by an insurer or any other
person, one or more of the following penalties may be imposed at
the commissioner's discretion:
(1) Suspension or revocation of the license of the
offending insurer or other person.
(2) Refusal, for a period not to exceed one year, to
issue a new license to the offending insurer or other person.
(3) A fine of not more than $5,000 for each violation of
this act.
(4) A fine of not more than $10,000 for each willful
violation of this act.
(b) Limitations.--
(1) Fines imposed against an individual insurer under
this act may not exceed $500,000 in the aggregate during a
single calendar year.
(2) Fines imposed against any other person under this
act may not exceed $100,000 in the aggregate during a single
calendar year.
(c) Additional remedies.--The enforcement remedies imposed
under this subsection are in addition to any other remedies or
penalties that may be imposed under any other applicable law of
this Commonwealth, including:
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(1) The act of July 22, 1974 (P.L.589, No.205), known as
the Unfair Insurance Practices Act. Violations of this act
shall be deemed to be an unfair method of competition and an
unfair or deceptive act or practice under the Unfair
Insurance Practices Act.
(2) The act of December 18, 1996 (P.L.1066, No.159),
known as the Accident and Health Filing Reform Act.
(3) The act of June 25, 1997 (P.L.295, No.29), known as
the Pennsylvania Health Care Insurance Portability Act.
(d) Administrative procedure.--The administrative provisions
of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies). A
party against whom penalties are assessed in an administrative
action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
Ch. 7 Subch. A (relating to judicial review of Commonwealth
agency action).
Section 6. Repeals.
All acts and parts of acts are repealed insofar as they are
inconsistent with this act.
Section 7. Applicability.
This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the department, this
act shall apply to any policy for which a form or rate is
first filed on or after the effective date of this section.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the department,
this act shall apply to any policy issued or renewed on or
after 180 days after the effective date of this section.
Section 8. Effective date.
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This act shall take effect immediately.
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