Bill > HB1828

This bill establishes a new chapter in Pennsylvania insurance law requiring health insurers to provide coverage for immunizations without cost-sharing, beginning January 1, 2025. The bill defines key terms like "immunization," "cost-sharing," and "enrollee" and empowers the Insurance Department, in consultation with the Department of Health, to add or remove immunizations from coverage requirements based on recommendations from medical organizations like the Advisory Committee on Immunization Practices. The bill allows insurers to use reasonable medical management techniques for determining immunization frequency and methods, and provides exceptions for grandfathered health care plans and religious exemptions. Insurers must cover out-of-network immunizations if no in-network provider is available. The bill establishes enforcement mechanisms, including potential penalties for non-compliance such as fines up to $5,000 per violation (or $10,000 for willful violations), license suspension, or revocation, with a maximum aggregate fine of $500,000 per calendar year. The legislation aims to improve access to immunizations by removing financial barriers and ensuring comprehensive coverage across health insurance policies in Pennsylvania.

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=1828