Bill > SB52

This bill, known as the Health Insurance Protection Against Limitations Act, establishes new regulations for health insurance policies in Pennsylvania. The legislation primarily focuses on prohibiting insurers from setting annual or lifetime dollar limits on "core benefits" for enrollees, regardless of whether providers are in-network or out-of-network. Core benefits are defined as those that had no annual or lifetime per-enrollee limits in individual or small group policies in 2018, with the potential for additional benefits to be specified by the Insurance Department through future regulations. The bill provides the Insurance Department authority to issue temporary and permanent regulations to implement these provisions, and establishes enforcement mechanisms including potential penalties for insurers who violate the act. Penalties can range from $5,000 to $10,000 per violation, with aggregate annual limits of $500,000 for insurers and $100,000 for other entities, and may include license suspension, revocation, or denial. The act will apply to new health insurance policy forms and rates filed after its effective date, with a 180-day transition period for policies not requiring form or rate filings. Importantly, the bill does not mandate coverage of specific benefits but aims to protect consumers from arbitrary financial limitations on core health insurance benefits.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=S&type=B&bn=52