Bill > SB51

This bill establishes comprehensive health insurance coverage requirements for individual and group health insurance policies in Pennsylvania, mandating that insurers provide coverage across ten core health benefit categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, and pediatric services. The bill requires that these health benefits be at least as comprehensive as those offered in 2018, with the Insurance Department having the authority to modify or add benefits through regulations, considering factors such as population health needs, potential discrimination, and accessibility. The legislation also establishes enforcement mechanisms, including potential penalties for insurers who violate the act, such as fines up to $5,000 per violation (or $10,000 for willful violations), license suspension, or revocation. The bill will apply to health insurance policies filed or renewed on or after a specified effective date, with the Insurance Department empowered to issue temporary regulations to facilitate implementation. Importantly, the bill aims to ensure more standardized and comprehensive health insurance coverage across individual and group plans in Pennsylvania, with a focus on protecting diverse population health needs.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=S&type=B&bn=51