Bill > HB1828

This bill aims to establish comprehensive immunization coverage requirements for health insurance policies in Pennsylvania, mandating that insurers provide coverage for immunizations without imposing any cost-sharing expenses for enrollees. The bill defines key terms like "immunization" (referring to vaccines required to be covered as of January 1, 2025), "cost-sharing" (out-of-pocket expenses like deductibles and copayments), and specifies the role of the Department of Health in determining which immunizations must be covered. The legislation allows the department to add or remove immunizations from coverage based on recommendations from medical organizations like the Advisory Committee on Immunization Practices, considering factors such as medical evidence and public health impact. Insurers are required to cover immunizations for non-grandfathered health plans, with some flexibility in network considerations, such as not being obligated to cover out-of-network providers unless no in-network provider is available. The bill also establishes enforcement mechanisms, including potential penalties for insurers who violate the immunization coverage requirements, 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.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=H&type=B&bn=1828