PRINTER'S NO. 376
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.404
Session of
2025
INTRODUCED BY PASHINSKI, FRANKEL, KHAN, FREEMAN, KINKEAD,
HADDOCK, HANBIDGE, SIEGEL, GIRAL, SHUSTERMAN, BOROWSKI,
PROBST, McNEILL, HILL-EVANS, T. DAVIS, HARKINS, CEPEDA-
FREYTIZ, D. WILLIAMS, SANCHEZ, VENKAT, MUNROE, BENHAM, OTTEN,
ABNEY, BRENNAN, HOWARD, INGLIS, STEELE, GUENST, CARROLL,
KENYATTA, HOHENSTEIN, CERRATO, WAXMAN, KAZEEM, DALEY, CIRESI,
MERSKI, PIELLI, WARREN, SAMUELSON, BRIGGS, DONAHUE, BOYD,
SCHLOSSBERG, CONKLIN, NEILSON, DEASY, GREEN, BURGOS,
A. BROWN, ISAACSON AND MAYES, JANUARY 29, 2025
REFERRED TO COMMITTEE ON INSURANCE, JANUARY 29, 2025
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, further
providing for conditions subject to which policies are to be
issued and for health insurance coverage for certain children
of insured parents.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Sections 617(A)(3) and (9) and 617.1 of the act
of May 17, 1921 (P.L.682, No.284), known as The Insurance
Company Law of 1921, are amended to read:
Section 617. Conditions Subject to Which Policies Are to Be
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20 Issued.--(A) No such policy shall be delivered or issued for
delivery to any person in this Commonwealth unless:
* * *
(3) it purports to insure only one person, except that a
policy may insure, originally or by subsequent amendment, upon
the application of an adult head of a family who shall be deemed
the policyholder, any two or more eligible members of that
family, including husband, wife, dependent children or any
children under a specified age which[ , except as provided under
section 617.1, shall not exceed nineteen ] shall be at least
twenty-six years and any other person dependent upon the
policyholder; and
* * *
(9) A policy delivered or issued for delivery after January
1, 1968, under which coverage of a dependent of a policyholder
terminates at a specified age shall, with respect to an
unmarried child covered by the policy prior to the attainment of
the age of [nineteen] twenty-six who is incapable of self-
sustaining employment by reason of [ mental retardation or
physical handicap] an intellectual or physical disability and
who became so incapable prior to attainment of age [ nineteen]
twenty-six and who is chiefly dependent upon such policyholder
for support and maintenance, not so terminate while the policy
remains in force and the dependent remains in such condition, if
the policyholder has within thirty-one days of such dependent's
attainment of the limiting age submitted proof of such
dependent's incapacity as described herein. The foregoing
provisions of this paragraph shall not require an insurer to
insure a dependent who [ is a mentally retarded or physically
handicapped child] has an intellectual or physical disability
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30 where the policy is underwritten on evidence of insurability
based on health factors set forth in the application or where
such dependent does not satisfy the conditions of the policy as
to any requirement for evidence of insurability or other
provisions of the policy, satisfaction of which is required for
coverage thereunder to take effect. In any such case the terms
of the policy shall apply with regard to the coverage or
exclusion from coverage of such dependent.
* * *
Section 617.1. Health Insurance Coverage for Certain
Children of Insured Parents.--(A) (1) A health insurance
policy offered, issued or renewed in this Commonwealth that
provides dependent coverage of children shall continue to make
such coverage available for an adult child who has not attained
the age of twenty-six prior to the date of issuance or renewal.
(2) With respect to a child who has not attained the age of
twenty-six, a health insurance policy:
(i) May define dependent for purposes of eligibility for
dependent coverage of children in terms of a relationship
between the child and the policyholder or certificate holder,
including as described in 26 U.S.C. § 152(f)(1) (relating to
dependent defined).
(ii) May not deny or restrict dependent coverage based on
any of the following or any combination of the following:
(a) The presence or absence of the child's financial
dependency on any other person.
(b) The residency of the child, whether by location,
including service area, or by residency with any other person.
(c) The marital status of the child.
(d) The child's enrollment in an academic or vocational
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30 educational institution.
(e) The child's employment status.
(3) A health insurance policy providing dependent coverage
of children may deny or limit coverage, or impose additional
conditions for coverage, for individuals not described in 26
U.S.C. § 152(f)(1).
(4) The terms of a health insurance policy providing
dependent coverage of children pursuant to this subsection may
not vary based on age .
(B) (1) An insurer that issues, delivers, executes or
renews a group health [care] insurance policy in this
Commonwealth under which coverage of a child would otherwise
terminate at a specified age shall, at the option of the
policyholder, provide coverage to a child of an insured employe
beyond that specified age, up through and including the age of
[29] twenty-nine, at the insured employe's expense, and provided
that the child meet all of the following requirements:
[(1)] (i) Is not married.
[(2)] (ii) Has no dependents.
[(3)] (iii) Is a resident of this Commonwealth or is
enrolled as a full-time student at an institution of higher
education.
[(4)] (iv) Is not provided coverage as a named subscriber,
insured, enrollee or covered person under any other group or
individual health insurance policy or enrolled in or entitled to
benefits under any government health care benefits program,
including benefits under [ Title XVIII of the Social Security Act
(49 Stat. 620, 42 U.S.C. § 1395 et seq.). ] 42 U.S.C. Ch. 7
Subch. XVIII (relating to health insurance for aged and
disabled).
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30 [(B)] (2) Insurers may determine increases in premiums
related to continuation of coverage for the adult dependent
[past the limiting age of nineteen ] twenty-six years of age or
older.
[(C)] (3) This section shall not include the following types
of insurance or any combination thereof:
[(1)] (i) Hospital indemnity.
[(2)] (ii) Accident.
[(3)] (iii) Specified disease.
[(4)] (iv) Disability income.
[(5)] (v) Dental.
[(6)] (vi) Vision.
[(7) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement. ] (vii) A policy under which
benefits are provided by the Federal Government to active or
former military personnel and their dependents.
[(8)] (viii) Medicare supplement.
[(9)] (ix) Long-term care.
(x) Credit only.
(xi) Fixed indemnity.
(xii) An automobile medical payment policy under 75 Pa.C.S.
(relating to vehicles).
(xiii) Worker's compensation.
[(10)] (xiv) Other limited benefit plans.
[(11) Individual health insurance policies.
(D)] (C) For the purpose of this section:
"Health [care] insurance policy" means a [group] health,
sickness or accident policy or subscriber contract or
certificate issued by an entity subject to any one of the
following:
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30 (1) This act, including section 630 and Article XXIV .
(2) The act of December 29, 1972 (P.L.1701, No.364) , known
as the "Health Maintenance Organization Act."
(3) The act of May 18, 1976 (P.L.123, No.54) , known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
[(5) Article XXIV.]
Section 2. The Insurance Commissioner shall transmit notice
to the Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulletin if any of the
following occurs:
(1) The Congress of the United States repeals 42 U.S.C.
§ 300gg-14, in whole or in part.
(2) A court of the United States abrogates, vacates or
invalidates 42 U.S.C. § 300gg-14, in whole or in part, or a
regulation implementing 42 U.S.C. § 300gg-14, in whole or in
part.
(3) The executive branch of the United States refuses to
enforce or repeals a regulation implementing 42 U.S.C. §
300gg-14, in whole or in part.
Section 3. The implementation of this act shall be limited
to the provisions necessary to achieve a substitute coverage
requirement for the portion or portions of 42 U.S.C. § 300gg-14
that are impacted by the occurrence of any of the events
described in section 2 of this act.
Section 4. All acts and parts of acts are repealed insofar
as they are inconsistent with this act.
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30 Section 5. This act shall take effect as follows:
(1) The following provisions of this act shall take
effect immediately:
Section 2.
Section 3.
This section.
(2) The remainder of this act shall take effect upon
publication of the notice in section 2 of this act.
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