Bill > HB618

This bill, known as the Health Insurance Access Protection Act, establishes comprehensive protections for health insurance consumers in Pennsylvania by prohibiting insurers from discriminating against individuals based on preexisting conditions or health factors. The bill prevents insurance companies from denying coverage, excluding benefits, or charging higher premium rates for individuals with specific health conditions or characteristics in both individual and group health insurance markets. Premium rates can only vary based on limited factors such as family size, geographic rating area, age (with a maximum 3:1 ratio for adults), and tobacco use (with a maximum 1.5:1 ratio). The bill requires insurers to consider all enrollees in individual and small group markets as part of a single risk pool, which helps spread risk and potentially stabilize premiums. The Insurance Department is given authority to define geographic rating areas and age bands, and to adjust rating variations. The legislation also establishes enforcement mechanisms, including potential penalties for insurers who violate these provisions, such as fines up to $5,000 per violation, license suspension, or revocation. Additionally, the bill includes provisions for notifying the Legislative Reference Bureau if federal healthcare laws or regulations related to health insurance protections are repealed, invalidated, or not enforced, which could trigger specific implementation actions.

Budget and Finance, Business and Industry

https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=H&type=B&bn=618