PRINTER'S NO. 97
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.50
Session of
2025
INTRODUCED BY HUGHES, COLLETT, BOSCOLA, CAPPELLETTI, COMITTA,
COSTA, FLYNN, FONTANA, HAYWOOD, KANE, KEARNEY, KIM, MILLER,
MUTH, PISCIOTTANO, SANTARSIERO, SAVAL, SCHWANK, STREET,
TARTAGLIONE, A. WILLIAMS AND L. WILLIAMS, JANUARY 22, 2025
REFERRED TO BANKING AND INSURANCE, JANUARY 22, 2025
AN ACT
Providing for health care insurance coverage protections, for
duties of the Insurance Department and the Insurance
Commissioner, 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 Access Protection 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:
"Affordable Care Act." Collectively, the Patient Protection
and Affordable Care Act (Public Law 111-148, 124 Stat. 119) and
the Health Care and Education Reconciliation Act of 2010 (Public
Law 111-152, 124 Stat. 1029).
"Commissioner." The Insurance Commissioner of the
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18 Commonwealth.
"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.
"Grandfathered health plan." Individual or group health
insurance coverage in which an individual was enrolled prior to
the date of enactment of the Affordable Care Act or as otherwise
specified in 42 U.S.C. ยง 18011 (relating to preservation of
right to maintain existing coverage).
"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 factor." An element related to an individual's
physical or mental makeup, including:
(1) Health status.
(2) Medical condition.
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability, including conditions
arising out of acts of domestic violence.
(8) Disability.
"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:
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30 (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) Any other similar policies 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.
"Individual market." The market for health insurance
coverage offered to individuals other than in connection with a
group.
"Insurer." An entity that offers, issues or renews an
individual health insurance policy 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 that act.
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30 (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).
"Pre-existing condition." A health condition present before
the date of enrollment for coverage, or, if coverage is denied,
the date of the denial, whether or not any medical advice,
diagnosis, care or treatment was recommended or received before
that date.
"Small group market." The market for health insurance for
coverage offered through a group health insurance policy for a
group of 2 to 50 individuals, exclusive of their dependents.
"Wellness program." A program offered by an employer that is
designed to promote health or prevent disease.
Section 3. Prohibitions concerning discrimination based on pre-
existing conditions or health factors.
(a) Prohibition concerning eligibility for and enrollment in
health insurance.--An insurer offering, issuing or renewing an
individual health insurance policy or group health insurance
policy may not impose any rule for initial or continued
eligibility of any individual to enroll in or renew a health
insurance policy based on any pre-existing condition or health
factor in relation to an individual or a dependent of the
individual.
(b) Prohibition concerning premium rates.--
(1) An insurer offering, issuing or renewing an
individual health insurance policy or group health insurance
policy may not require an individual to pay a premium rate
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30 that is greater than the premium rate for a similarly
situated individual enrolled in the policy on the basis of
any pre-existing condition or health factor in relation to an
individual or a dependent of the individual.
(2) Nothing in paragraph (1) shall be construed to
prevent an insurer offering a group health insurance policy
from establishing premium discounts or rebates or modifying
otherwise applicable copayments or deductibles in return for
adherence to a wellness program. Pending the promulgation of
regulations by the department, a wellness program shall be
subject to limitations as may be established in Federal law
or regulation.
(c) Prohibition concerning benefit coverage.--An insurer
offering, issuing or renewing an individual health insurance
policy or group health insurance policy may not exclude or deny
coverage for any benefit provided for in a policy based on any
pre-existing condition or health factor in relation to an
individual or a dependent of the individual.
Section 4. Limitations on premium rating factors.
(a) Rate variation.--With respect to the premium rate
charged by an insurer for health insurance coverage offered in
the individual market or small group market, the premium rate
may only vary for a particular plan or coverage based on the
following:
(1) Family size.
(2) Geographic rating area.
(3) Age, except that the rate shall not vary by more
than 3 to 1 for adults except as provided under subsection
(d).
(4) Tobacco use, except that the rate shall not vary by
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30 more than 1.5 to 1 except as provided under subsection (d).
(b) Geographic rating areas.--The department may specify the
geographic rating areas by pu blication on the department's
publicly accessible Internet website and transmission of a
notice to the Legislative Reference Bureau for publication in
the next available issue of the Pennsylvania Bulletin. Prior to
publication, the department shall provide a 30-day comment
period and shall consult with insurers offering health insurance
policies in this Commonwealth.
(c) Age bands.--The department may define the permissible
age bands for rating purposes by publication on the department's
publicly accessible Internet website and transmission of a
notice to the Legislative Reference Bureau for publication in
the next available issue of the Pennsylvania Bulletin. Pri or to
publication, the department shall provide a 30-day comment
period and shall consult with insurers offering health insurance
policies in this Commonwealth.
(d) Adjustment of age and tobacco rating variations.--The
department may, by regulation, adjust the rating bands for age
and tobacco use.
Section 5. Single risk pools.
(a) Individual market.--An insurer shall consider all
enrollees in all health insurance policies offered by the
insurer in the individual market, other than grandfathered
health plans, to be members of a single risk pool.
(b) Small group market.--An insurer shall consider all
enrollees in all health insurance policies offered by the
insurer in the small group market, other than grandfathered
health plans, to be members of a single risk pool.
Section 6. Regulations.
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30 (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) In order to facilitate the prompt implementation of
this act, the department may issue temporary regulations,
which shall expire not 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) Section 204(b) 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),
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 paragraph. Regulations adopted
after the two-year period shall be promulgated as provided by
statute.
Section 7. Enforcement.
(a) Penalties.--Upon satisfactory evidence of a violation of
this act by an insurer or any other person, one or more of the
following penalties may be imposed at the commissioner's
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30 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 section are in addition to any other remedies or
penalties that may be imposed under any other applicable law of
this Commonwealth, including:
(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
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30 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 8. Repeals.
All acts and parts of acts are repealed insofar as they are
inconsistent with this act.
Section 9. Effective date.
This act shall take effect immediately.
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