Bill > SB268

This bill amends The Insurance Company Law of 1921 to establish rules for calculating cost-sharing in health insurance policies. Specifically, when determining an insured person's contribution to cost-sharing requirements, insurers and pharmacy benefits managers (PBMs) must include all cost-sharing amounts paid by the insured or on their behalf. The bill defines key terms such as "cost-sharing" (out-of-pocket expenses like copayments, deductibles, and coinsurance), "health insurance policy" (covering various types of health, sickness, and accident insurance policies), and "pharmacy benefits manager" (entities managing pharmacy benefits). The legislation applies to health insurance policies issued, renewed, or entered into on or after the effective date, which is 60 days after enactment. The bill excludes certain types of insurance from its scope, such as accident-only, dental, vision, and workers' compensation insurance. The primary goal is to provide more transparency and potentially reduce the financial burden on insured individuals by ensuring all cost-sharing contributions are accurately calculated.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=S&type=B&bn=268