HB 1140 — An Act providing for access to contraceptives; imposing duties on the Insurance Department and the Department of Human Services; providing for severability; and imposing penalties.

PRINTER'S NO.    1449

                   THE GENERAL ASSEMBLY OF PENNSYLVANIA



                       HOUSE BILL
                       No. 1140
                                             Session of
                                               2025

     INTRODUCED BY KRUEGER, VENKAT, KINKEAD, WAXMAN, GIRAL, BOROWSKI,
        HILL-EVANS, PROBST, MALAGARI, GUENST, SMITH-WADE-EL, RABB,
        PIELLI, MADDEN, FIEDLER, CURRY, HOHENSTEIN, SANCHEZ, OTTEN,
        BOYD, KENYATTA, D. WILLIAMS, O'MARA, RIVERA, DAVIDSON,
        CERRATO, STEELE AND SCHLOSSBERG, APRIL 22, 2025

     REFERRED TO COMMITTEE ON INSURANCE, APRIL 22, 2025


                                    AN ACT
 1   Providing for access to contraceptives; imposing duties on the
 2      Insurance Department and the Department of Human Services;
 3      providing for severability; and imposing penalties.
 4      The General Assembly of the Commonwealth of Pennsylvania
 5   hereby enacts as follows:
 6   Section 1.   Short title.
 7      This act shall be known and may be cited as the Contraceptive
 8   Access for All Act.
 9   Section 2.   Definitions.
10      The following words and phrases when used in this act shall
11   have the meanings given to them in this section unless the
12   context clearly indicates otherwise:
13      "Agreement with the Department of Human Services."     An
14   agreement between an MA or CHIP managed care plan and the
15   Department of Human Services to manage the purchase and
16   provision of services.
17      "Cost sharing."    As follows:
 1          (1)    The share of the health care costs covered by an MA
 2      or CHIP managed care plan or a health insurance policy that
 3      an enrollee or covered person pays out of pocket.
 4          (2)    The term includes a deductible, coinsurance,
 5      copayment or similar charge.
 6          (3)    The term does not include a premium, a balance
 7      billed amount from an out-of-network provider or the cost of
 8      a noncovered service.
 9      "Covered person."      A policyholder, subscriber, covered person
10   or other individual who is entitled to receive health care
11   services under a health insurance policy.
12      "Department."      The Insurance Department of the Commonwealth.
13      "Enrollee."      An individual who is entitled to receive health
14   care services under an agreement with the Department of Human
15   Services.
16      "FDA."    The United States Food and Drug Administration.
17      "Health care provider."      An individual who is authorized to
18   practice some component of the healing arts by a license,
19   permit, certificate or registration issued by a Commonwealth
20   licensing agency or board.
21      "Health insurance policy."      As follows:
22          (1)    A policy, subscriber contract, certificate or plan
23      issued by a health insurer that provides medical or health
24      care coverage.
25          (2)    The term does not include any of the following:
26                (i)    An accident only policy.
27                (ii)    A credit only policy.
28                (iii)    A long-term care policy.
29                (iv)    A disability income policy.
30                (v)    A specified disease policy.

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 1                (vi)    A Medicare supplement policy.
 2                (vii)    A fixed indemnity policy.
 3                (viii)    A dental only policy.
 4                (ix)    A vision only policy.
 5                (x)    A workers' compensation policy.
 6                (xi)    An automobile medical payment policy.
 7                (xii)    A policy under which benefits are provided by
 8          the Federal Government to active or former military
 9          personnel and their dependents.
10                (xiii)    A hospital indemnity policy.
11                (xiv)    Any other similar policy providing for limited
12          benefits.
13      "Health insurer."     An entity licensed by the department that
14   offers, issues or renews an individual or group health insurance
15   policy that is offered or governed under any of the following:
16          (1)   The act of May 17, 1921 (P.L.682, No.284), known as
17      The Insurance Company Law of 1921, including section 630 and
18      Article XXIV thereof.
19          (2)   The act of December 29, 1972 (P.L.1701, No.364),
20      known as the Health Maintenance Organization Act.
21          (3)   40 Pa.C.S. Ch. 61 (relating to hospital plan
22      corporations) or 63 (relating to professional health services
23      plan corporations).
24      "Medical Assistance or CHIP managed care plan" or "MA or CHIP
25   managed care plan."     A health care plan that uses a gatekeeper
26   to manage the utilization of health care services by medical
27   assistance or children's health insurance program enrollees and
28   integrates the financing and delivery of health care services.
29      "Out-of-network provider."     A health care provider who does
30   not contract with an MA or CHIP managed care plan or a health

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 1   insurer to provide health care services to an enrollee or
 2   covered person.
 3      "Prior authorization."          As defined in section 2102 of The
 4   Insurance Company Law of 1921.
 5      "Step therapy."          As defined in section 2102 of The Insurance
 6   Company Law of 1921.
 7   Section 3.     Minimum coverage requirements.
 8      (a)   Mandatory coverage.--
 9            (1)   Except as provided in section 5 and subject to
10      subsection (e), an MA or CHIP managed care plan or health
11      insurance policy offered, issued or renewed in this
12      Commonwealth shall provide coverage for all of the following:
13                  (i)    Any of the following for which an enrollee or
14            covered person obtained a prescription:
15                         (A)   An FDA-approved contraceptive drug.
16                         (B)   An FDA-approved, cleared or granted
17                  contraceptive device or other product.
18                  (ii)    All FDA-approved over-the-counter emergency
19            contraceptive drugs, including levonorgestrel and
20            ulipristal acetate, for which an enrollee or covered
21            person obtained a prescription or which is the subject of
22            a standing order issued under section 4. Coverage
23            provided under this subparagraph shall not be subject to
24            prior authorization or step therapy.
25                  (iii)    All FDA-approved over-the-counter oral
26            contraceptive drugs, for which an enrollee or covered
27            person obtained a prescription or which is the subject of
28            a standing order issued under section 4. Coverage
29            provided under this subparagraph shall not be subject to
30            prior authorization or step therapy.

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 1             (iv)    FDA-approved prescription oral contraceptives
 2        intended to last for not more than a three-month period
 3        for the first time that the prescription oral
 4        contraceptive drug is dispensed to the enrollee or
 5        covered person.
 6             (v)    (A)   Subject to clause (B), FDA-approved
 7             prescription oral contraceptive drugs intended to
 8             last for not more than a 12-month period for any
 9             refill or subsequent dispensing of the prescription
10             oral contraceptive drug initially prescribed under
11             subparagraph (i) or (iv). Prescription oral
12             contraceptive drugs provided under this subparagraph
13             may be dispensed all at once or over the course of
14             the 12-month period, regardless of whether the
15             enrollee or covered person was enrolled in an MA or
16             CHIP managed care plan or health insurance policy at
17             the time the prescription oral contraceptive drug was
18             first dispensed.
19                    (B)   An enrollee or covered person may not fill
20             more than one 12-month prescription oral
21             contraceptive drug in a single calendar year.
22             (vi)    Voluntary adult male and voluntary adult female
23        sterilization surgery.
24             (vii)    Items and services integral to the furnishing
25        of contraceptive drugs, devices and products or voluntary
26        sterilization surgery, including patient screening,
27        education and counseling and items and services related
28        to the evaluation, insertion or removal of a
29        contraceptive device or continuance or discontinuance of
30        a contraceptive drug, device or other product.

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 1            (2)   Nothing in this subsection shall be construed to:
 2                  (i)    Require coverage of male condoms.
 3                  (ii)    Exclude, limit or prohibit coverage for
 4            contraceptive drugs, devices and products used for other
 5            than contraceptive purposes.
 6      (b)   Cost sharing prohibited.--Except as provided in
 7   subsection (e)(1)(i)(B), coverage under subsection (a) shall be
 8   provided without imposing any form of cost sharing.
 9      (c)   Conditions for coverage.--Except for over-the-counter
10   emergency contraceptive drugs described in subsection (a)(1)(ii)
11   and over-the-counter oral contraceptive drugs described in
12   subsection (a)(1)(iii), an MA or CHIP managed care plan or
13   health insurance policy may require that items and services
14   described in subsection (a) are medically necessary or
15   appropriate as a condition of coverage.
16      (d)   Compliance with law.--An MA or CHIP managed care plan or
17   health insurer that imposes prior authorization or step therapy
18   on the items or services described in subsection (c) shall
19   comply with all applicable Federal and State laws and guidance
20   concerning prior authorization and step therapy, including:
21            (1)   Section 2155 of the act of May 17, 1921 (P.L.682,
22      No.284), known as The Insurance Company Law of 1921.
23            (2)   Section 2156 of The Insurance Company Law of 1921.
24            (3)   Subdivision (i) of Article XXI of The Insurance
25      Company Law of 1921.
26            (4)   Subdivision (i.1) of Article XXI of The Insurance
27      Company Law of 1921.
28      (e)   Out-of-network providers.--
29            (1)   (i)    Subject to subparagraph (ii), nothing in
30            subsection (a) shall:

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 1                         (A)   Require a health insurer that has a network
 2                  of providers to provide benefits for contraceptive
 3                  care covered under subsection (a) that are delivered
 4                  by an out-of-network provider.
 5                         (B)   Preclude a health insurer that has a network
 6                  of providers from imposing cost-sharing requirements
 7                  for contraceptive care covered under subsection (a)
 8                  that are delivered by an out-of-network provider.
 9                  (ii)    If a health insurer does not have in its
10            network a provider that can provide contraceptive care
11            covered under subsection (a), the health insurer shall
12            cover the contraceptive care when performed by an out-of-
13            network provider and may not impose cost sharing with
14            respect to the contraceptive care.
15            (2)   Nothing in this section shall be construed as
16      limiting an enrollee's ability to receive contraceptive care
17      from a health care provider in accordance with 42 CFR 431.51
18      (relating to free choice of providers).
19   Section 4.     Standing order.
20      (a)   Permissible acts.--Notwithstanding any other provision
21   of law, a health care provider otherwise authorized to prescribe
22   FDA-approved over-the-counter emergency contraceptive drugs or
23   FDA-approved over-the-counter oral contraceptive drugs may
24   dispense, prescribe or distribute the drugs directly or by a
25   standing order to a person within this Commonwealth.
26      (b)   Issuance of standing order.--The Secretary of Health or
27   the Physician General of the Commonwealth shall issue a
28   Statewide standing order in accordance with subsection (a) for
29   FDA-approved over-the-counter emergency contraceptive drugs and
30   FDA-approved over-the-counter oral contraceptive drugs.

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 1      (c)   Liability.--
 2            (1)   Subject to paragraph (2), a health care provider
 3      who, acting in good faith, prescribes or dispenses a drug
 4      pursuant to a standing order under this section shall not be
 5      subject to any criminal or civil liability or any
 6      professional disciplinary action for:
 7                  (i)    prescribing or dispensing the drug; or
 8                  (ii)    any outcomes resulting from the eventual
 9            administration of the FDA-approved over-the-counter
10            emergency contraceptive drug or FDA-approved over-the-
11            counter oral contraceptive drug.
12            (2)   The immunity under paragraph (1) shall not apply to
13      a health care provider who acts with intent to harm or with
14      reckless indifference to a substantial risk of harm.
15   Section 5.     Religious or moral exemption.
16      (a)   General rule.--Notwithstanding the act of December 9,
17   2002 (P.L.1701, No.214), known as the Religious Freedom
18   Protection Act, and except as provided in subsection (b), a
19   health insurance policy issued to an entity or individual that
20   objects to coverage or payments for contraceptive services under
21   45 CFR 147.132 (relating to religious exemptions in connection
22   with coverage of certain preventive health services) or 147.133
23   (relating to moral exemptions in connection with coverage of
24   certain preventive health services) is exempt from section 3.
25      (b)   Exception.--An exemption under subsection (a) shall not
26   apply to contraceptive drugs, devices or products used for
27   purposes other than contraceptive purposes.
28      (c)   Notice.--An objecting entity exempt from section 3 shall
29   provide written notice to employees and prospective employees
30   that health insurance coverage maintained by the entity limits

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 1   or does not provide coverage of contraceptive care described in
 2   section 3(a). The notice shall indicate whether any
 3   contraceptive care is covered and, if so, under what conditions.
 4   Section 6.   Confidentiality.
 5      (a)   Alternative means of communication.--An MA or CHIP
 6   managed care plan or health insurer must permit and accommodate
 7   a reasonable request by an enrollee or covered person to receive
 8   communications from the MA or CHIP managed care plan or health
 9   insurer regarding the receipt of contraceptive care covered
10   under section 3 by alternative means or at alternative
11   locations. A request is reasonable if the enrollee or covered
12   person states clearly that the disclosure of all or part of that
13   information could endanger the enrollee or covered person.
14      (b)   Request in writing.--An MA or CHIP managed care plan or
15   health insurer may require the enrollee or covered person to
16   make a request for confidential communication described in
17   subsection (a) in writing.
18      (c)   Condition.--An MA or CHIP managed care plan or health
19   insurer may condition the provision of a reasonable
20   accommodation on specification of an alternative address or
21   other method of contact.
22      (d)   Required statement.--An MA or CHIP managed care plan or
23   health insurer may require that a request for alternative
24   communication under subsection (a) contain a statement that
25   disclosure of all or part of the information to which the
26   request pertains could endanger the enrollee or covered person.
27      (e)   Denials and requests for additional information.--If an
28   MA or CHIP managed care plan or health insurer denies or
29   requests additional information from the covered person or
30   enrollee regarding a request for confidential communications,

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 1   the MA or CHIP managed care plan or health insurer shall
 2   transmit the denial or request to the covered person or enrollee
 3   in accordance with the alternative means or alternative
 4   locations selected by the covered person or enrollee in the
 5   request for confidential communications.
 6   Section 7.     Reporting requirements.
 7      (a)   Information required.--Medical assistance or CHIP
 8   managed care plans and health insurers shall annually report to
 9   the department the number, type and disposition of each
10   complaint, grievance, internal appeal and adverse benefit
11   determination filed with the MA or CHIP managed care plan or
12   health insurer regarding contraceptive care.
13      (b)   Inclusion in annual report.--The information received
14   under subsection (a) shall be included in the annual reports
15   submitted by the department under section 2181(f) of the act of
16   May 17, 1921 (P.L.682, No.284), known as The Insurance Company
17   Law of 1921.
18      (c)   Definitions.--As used in this section, the terms
19   "adverse benefit determination," "complaint" and "grievance"
20   shall have the meanings given to them in section 2102 of The
21   Insurance Company Law of 1921.
22   Section 8.     Enforcement.
23      (a)   Penalties.--Upon satisfactory evidence of the violation
24   of this act by an MA or CHIP managed care plan, health insurer
25   or other person, subject to subsection (b), one or more of the
26   following penalties may be imposed at the discretion of the
27   Insurance Commissioner or the Department of Human Services, as
28   appropriate:
29            (1)   Suspension or revocation of the license of the
30      offending health insurer.

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 1            (2)   Refusal, for a period not to exceed one year, to
 2      issue a new license to the offending health insurer.
 3            (3)   A fine of not more than $5,000 for each violation of
 4      this act.
 5            (4)   A fine of not more than $10,000 for each willful
 6      violation of this act.
 7      (b)   Limitations.--
 8            (1)   Fines imposed against an MA or CHIP managed care
 9      plan or health insurer under this act may not exceed $500,000
10      in the aggregate during a single calendar year.
11            (2)   Fines imposed against any other person under this
12      act may not exceed $100,000 in the aggregate during a single
13      calendar year.
14      (c)   Additional remedies.--The enforcement remedies imposed
15   under this section are in addition to any other remedies or
16   penalties that may be imposed under any other applicable law of
17   this Commonwealth, including:
18            (1)   The act of July 22, 1974 (P.L.589, No.205), known as
19      the Unfair Insurance Practices Act. A violation of this act
20      shall be deemed to be an unfair method of competition and
21      unfair or deceptive act or practice under that act.
22            (2)   The act of December 18, 1996 (P.L.1066, No.159),
23      known as the Accident and Health Filing Reform Act.
24            (3)   The act of June 25, 1997 (P.L.295, No.29), known as
25      the Pennsylvania Health Care Insurance Portability Act.
26      (d)   Administration.--
27            (1)   The provisions of this section shall be subject to 2
28      Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of
29      Commonwealth agencies).
30            (2)   A party against whom penalties are assessed in an

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 1      administrative action under this section may appeal to
 2      Commonwealth Court as provided in 2 Pa.C.S. Ch. 7 Subch. A
 3      (relating to judicial review of Commonwealth agency action).
 4   Section 9.     Regulations.
 5      (a)   Department of Human Services.--The Department of Human
 6   Services may promulgate necessary and appropriate regulations
 7   with respect to MA or CHIP managed care plans to implement,
 8   administer and enforce this act.
 9      (b)   Insurance Department.--The department may promulgate
10   necessary and appropriate regulations with respect to health
11   insurers and health insurance policies to implement, administer
12   and enforce this act.
13   Section 10.     Applicability.
14      This act shall apply as follows:
15            (1)   For health insurance policies for which either rates
16      or forms are required to be filed with the Federal Government
17      or the department, this act shall apply to any policy for
18      which a form or rate is first filed on or after the effective
19      date of this paragraph.
20            (2)   For health insurance policies for which neither
21      rates nor forms are required to be filed with the Federal
22      Government or the department, this act shall apply to any
23      policy issued or renewed on or after 180 days after the
24      effective date of this paragraph.
25   Section 11.     Severability.
26      The provisions of this act are severable. If a provision of
27   this act or the provision's application to a person or
28   circumstance is held invalid, the invalidity shall not affect
29   other provisions or applications of this act which can be given
30   effect without the invalid provision or application.

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1   Section 12.   Effective date.
2      This act shall take effect in 60 days.




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