Bill > HB1863

This bill establishes a Public Option Program within Pennsylvania's Insurance Department to provide health insurance coverage in the individual, small group, and potentially large group markets. The program will offer health insurance policies that include comprehensive coverage of essential health benefits, such as preventive care, emergency services, prescription drugs, mental health services, and more, with coverage available for dependents up to age 26 and dental and vision benefits. The insurance policies will be designed to be more affordable, with premiums set at progressively lower rates compared to reference premiums: 5% lower in the first year, increasing to 15% lower by the fourth year. The program will limit provider reimbursement rates to no more than 160% of Medicare rates and will require health care practitioners and facilities to enroll to participate. A dedicated Public Option Program Fund will be established in the State Treasury to support the program, with funding potentially coming from legislative appropriations, grants, and donations. The Insurance Department will be required to produce annual reports detailing the program's effectiveness, including enrollment numbers, demographic information, and financial details, which will be distributed to various state legislative leaders and posted publicly. The program's implementation will begin 365 days after the act's passage, with other provisions taking effect immediately.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=H&type=B&bn=1863