HOUSE COMMITTEE ON APPROPRIATIONS
FISCAL NOTE
HOUSE BILL NO. 535 PRINTER’ S NO. 528 PRIME SPONSOR: Frankel
COST
I (SAVINGS) FUND FY 2024/25 FY 2025/26
Insurance Regulation and Oversight Fund See Fiscal Impact See Fiscal Impact
SUMMARY:
This legislation prohibits health insurance companies from imposing annual and lifetime limits to the dollar
value of core benefits provided under the policy to the enrollee.
ANALYSIS:
House Bill 535, Printer’s Number 528, known as the Health Insurance Protection Against Limitations
Act, prohibits a health insurance company that offers, issues, or renews an individual or group health
insurance policy from imposing annual or lifetime limits on the dollar value of core benefits provided
under the policy to an enrollee.
Core benefits include a benefit for which no annual or lifetime per enrollee limit was permitted to be
included in an individual or small group health insurance policy offered or issued in the commonwealth.
The Department of Insurance may promulgate regulations as may be necessary and appropriate to carry
out the provisions of this legislation.
Health insurance companies that violate the requirements in this legislation may have a fine imposed at
the Insurance Commissioner’s discretion. Fines may be assessed for not more than $5,000 for each
violation and $10,000 for each willful violation. Fines imposed may not exceed $500,000 in aggregate
during a single calendar year against an individual insurer, and $100,000 in aggregate during a single
calendar year against any other person subject to this legislation.
The Insurance Commissioner will transmit notice to the Legislative Reference Bureau for publication in
the next available issue of the Pennsylvania Bulletin if the United States Congress repeals federal
regulations that prohibit annual or lifetime limits, a court of the United States abrogates, vacates, or
invalidates these federal regulations, or if the executive branch of the United States refuses to enforce or
repeals these federal regulations.
The requirement for the Insurance Commissioner to transmit notice takes effect immediately upon the
enactment of this legislation. The remainder of the legislation takes effect upon publication of the notice.
FISCAL IMPACT:
The Department of Insurance oversees health insurance companies’ compliance with requirements,
including compliance with this legislation. Additionally, the department investigates any potential
compliance issues and, if necessary, imposes fines. The department does not currently anticipate any
increase in administrative costs due to the requirements in this legislation.
The collection of fines imposed by the department, as provided for in this legislation, may result in
increased revenue received by the commonwealth. Revenue resulting from fines paid by health
insurance companies is deposited into the Insurance Regulation and Oversight Fund. An increase in
revenue received by the department due to the additional fines imposed and the payment of those fines
would increase the balance in this Fund. However, the number of health insurance companies that would
be found to be out of compliance with these requirements and have fines imposed by the department is
unknown at this time. Therefore, any increased revenue to the commonwealth is indeterminate.
PREPARED BY: Mara Perez, Senior Budget Analyst
House Appropriations Committee (D)
DATE: March 25, 2025
Estimates are calculated using the best information available. Actual costs and revenue impact incurred
may vary from estimates.