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07/25/2024 02:10 AM
Pennsylvania State Senate
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=S&SPick=20230&cosponId=38154
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Senate of Pennsylvania
Session of 2023 - 2024 Regular Session

MEMORANDUM

Posted: December 2, 2022 03:16 PM
From: Senator Judy Ward
To: All Senate members
Subject: Prohibiting Health Insurers from Altering Coverage or Premiums
 
I plan to reintroduce Senate Bill 828 from the prior session. This legislation amends the Unfair Insurance Practices Act to prohibit health insurers from altering the coverage or premiums included in an insured person’s health insurance policy during the policy term when an insured person has already received a specific treatment, service or prescription drug.

Many of us have encouraged our constituents to take control of their own health care needs by becoming diligent and smart shoppers in the health insurance marketplace. We urge them to find a plan that provides needed coverage, including the products, services, procedures, treatments and prescription drugs at a price they can afford. But what good does that do for our constituents if the health insurer can change its contract terms at any point during a contract year? The result is that insured people are left with little recourse and are forced to pay higher out-of-pocket costs for a benefit that was supposed to be covered, or they lose coverage of that benefit altogether. My legislation will end this practice.

This legislation is modeled after "Principle Number 5" of the American Medical Association document, Prior Authorization and Utilization Management Reform Principles. The policy principles are supported by such groups as the American Medical Association, American Hospital Association, American Pharmacists Association, American College of Cardiology and dozens more.

This measure provides protection for patients who are already receiving a benefit within the policy year of their health insurance contract. It does not impact an insurer’s ability to alter covered benefits for insured people who are not already receiving a specific service, treatment or prescription drug. Finally, this legislation does not apply to a benefit removed from coverage because it has been deemed unsafe by the FDA or when production of a prescription drug has been discontinued.

I understand and support the important role health care insurers play in administering health care benefits in a cost-effective manner. But I equally believe our constituents should get the coverage they paid for and have continued access to services and prescription drugs that are successfully treating their ailments.
 
Prior co-sponsors of Senate Bill 828 were Senators Brewster, Cappelletti and Collett.

Please join me in co-sponsoring this important legislation. If you have questions regarding this legislation, please reach out to Greg Beckenbaugh in my office at 717-787-5490 or gbeckenbaug@pasen.gov.



Introduced as SB348