PRINTER'S NO. 225
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.271
Session of
2025
INTRODUCED BY CAPPELLETTI, SCHWANK, PENNYCUICK, HAYWOOD, STREET,
COSTA, TARTAGLIONE, SANTARSIERO AND KANE, FEBRUARY 20, 2025
REFERRED TO BANKING AND INSURANCE, FEBRUARY 20, 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, providing
for coverage for anti-obesity treatments; and abrogating a
regulation.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.11. Coverage for Anti-Obesity Treatments.--(a)
All of the following shall be considered compensable items or
services under the Commonwealth's medical assistance program:
(1) Bariatric surgery and related treatments for obesity and
morbid obesity when the prescribing physician has issued a
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23 written order stating that treatment is in accordance with the
patient qualifications and treatment standards provided by the
American Society for Metabolic and Bariatric Surgery or the
American College of Surgeons, subject to the following:
(i) Related treatment may include, but not be limited to,
preoperative psychological screening and counseling, behavior
modification, weight loss, exercise regimens, nutritional
counseling and postoperative follow-up, overview and counseling
of dietary, exercise and lifestyle changes.
(ii) The insured shall be at least eighteen (18) years of
age.
(2) An anti-obesity drug when it is included:
(i) in the definition of "covered outpatient drug" under 42
U.S.C. § 1396r-8(k) (relating to payment for covered outpatient
drugs) and subject to 42 U.S.C. § 1396r-8(a)(1); and
(ii) on the Pennsylvania Medical Assistance Statewide
Preferred Drug List authorized under section 459.1 of the act of
June 13, 1967 (P.L.31, No.21), known as the "Human Services
Code."
(b) A health insurer that issues or renews a health
insurance policy providing benefits for medical or hospital
expenses to insureds residing in this Commonwealth shall provide
to the insured under the health insurance policy coverage for
all of the following:
(1) Bariatric surgery and related treatments for obesity and
morbid obesity when the prescribing physician has issued a
written order stating that treatment is in accordance with the
patient qualifications and treatment standards provided by the
American Society for Metabolic and Bariatric Surgery or the
American College of Surgeons, subject to the following:
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30 (i) Related treatment may include, but not be limited to,
preoperative psychological screening and counseling, behavior
modification, weight loss, exercise regimens, nutritional
counseling and postoperative follow-up, overview and counseling
of dietary, exercise and lifestyle changes.
(ii) The insured shall be at least eighteen (18) years of
age.
(iii) An entity subject to this subsection shall provide the
benefits required under this subsection to the same extent as
for other medically necessary surgical procedures and treatments
under the insured's contract or policy with the entity.
(2) An anti-obesity drug approved by the Food and Drug
Administration of the United States Department of Health and
Human Services.
(c) As used in this section:
(1) "Health insurance policy" means the following:
(i) A group or individual health or sickness or accident
insurance policy, subscriber contract or certificate issued by
an entity subject to any one of the following:
(A) Section 630 and Article XXIV of this act.
(B) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(C) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(ii) The term does not include accident only, fixed
indemnity, hospitality indemnity, limited benefit, credit,
dental, vision, specified disease, Medicare supplement, Civilian
Health and Medical Program of the Uniformed Services supplement,
long-term care or disability income, workers' compensation or
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30 automobile medical payment insurance.
(2) "Health insurer" means an entity licensed by the
Insurance Department with accident and health authority to issue
a policy, subscriber contract, certificate or plan that provides
medical or health care coverage that is offered or governed
under any of the following:
(i) This act.
(ii) The "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Ch. 61 or 63.
(3) "Insured" means a person on whose behalf an insurer is
obligated to pay covered health care expense benefits or provide
health care services under a health insurance policy. The term
includes:
(i) A policyholder, subscriber, certificate holder, member,
dependent or other individual who is eligible to receive health
care services through a health insurance policy.
(ii) All individuals named in a health insurance policy
issued by a health insurer.
Section 2. The addition of section 635.11 of the act shall
apply to health insurance policies offered, issued or renewed on
or after the effective date of this section.
Section 3. The provisions of 55 Pa. Code § 1121.54(1) are
abrogated insofar as they are inconsistent with the addition of
section 635.11(a)(2) of the act.
Section 4. This act shall take effect in 60 days.
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