Bill > HB535

This bill, called the Health Insurance Protection Against Limitations Act, establishes new regulations for health insurance policies in Pennsylvania by prohibiting insurers from setting annual or lifetime dollar value limits on core health benefits for enrollees, regardless of whether the provider is in-network or out-of-network. The bill defines key terms such as "enrollee" (a person entitled to receive health care services), "health insurance policy" (a plan providing medical coverage, with numerous specific exclusions), and specifies that this restriction applies to both individual and group health insurance policies. The legislation empowers the Insurance Department to create regulations for implementation and provides the Insurance Commissioner with enforcement mechanisms, including the ability to impose penalties like license suspension, fines up to $5,000 per violation (or $10,000 for willful violations), with annual aggregate fine limits. The bill is specifically designed to maintain protections similar to federal regulations (42 U.S.C. § 300gg-11) regarding health insurance coverage limits, and includes provisions for notifying relevant authorities if federal standards change. Importantly, the bill does not mandate coverage of specific benefits but aims to prevent insurers from establishing arbitrary financial limits on core health services.