HB 1184 — An Act imposing a moratorium on enactment of new or expanded health insurance policy mandated benefits; and requiring the Legislative Budget and Finance Committee to study the issue of health insurance mandates and report to the General Assembly.

PRINTER'S NO.    1333

                   THE GENERAL ASSEMBLY OF PENNSYLVANIA



                       HOUSE BILL
                       No. 1184
                                              Session of
                                                2025

     INTRODUCED BY KEPHART, KAUFFMAN, COOK, ARMANINI, GROVE, KUZMA
        AND ZIMMERMAN, APRIL 9, 2025

     REFERRED TO COMMITTEE ON INSURANCE, APRIL 9, 2025


                                   AN ACT
 1   Imposing a moratorium on enactment of new or expanded health
 2      insurance policy mandated benefits; and requiring the
 3      Legislative Budget and Finance Committee to study the issue
 4      of health insurance mandates and report to the General
 5      Assembly.
 6      The General Assembly of the Commonwealth of Pennsylvania
 7   hereby enacts as follows:
 8   Section 1.   Short title.
 9      This act shall be known and may be cited as the State-
10   mandated Benefit Moratorium Act.
11   Section 2.   Definitions.
12      The following words and phrases when used in this act shall
13   have the meanings given to them in this section unless the
14   context clearly indicates otherwise:
15      "Committee."   The Legislative Budget and Finance Committee.
16      "Health care provider."   A health care facility, medical
17   equipment supplier or person that is licensed, certified or
18   otherwise regulated to provide health care services under the
19   laws of this Commonwealth or another state.
 1      "Health insurance policy."       As follows:
 2          (1)     A policy, subscriber contract, certificate or plan
 3      issued by an insurer that provides medical or health care
 4      coverage.
 5          (2)     The term includes:
 6                (i)    A dental only policy.
 7                (ii)    A vision only policy.
 8          (3)     The term does not include:
 9                (i)    An accident only policy.
10                (ii)    A credit only policy.
11                (iii)    A long-term care or disability income policy.
12                (iv)    A specified disease policy.
13                (v)    A Medicare supplement policy.
14                (vi)    A TRICARE policy, including a Civilian Health
15          and Medical Program of the Uniformed Services (CHAMPUS)
16          Supplement Policy.
17                (vii)    A fixed indemnity policy.
18                (viii)    A hospital indemnity policy.
19                (ix)    A workers' compensation policy.
20                (x)    An automobile medical payment policy under 75
21          Pa.C.S. (relating to vehicles).
22                (xi)    A homeowner's insurance policy.
23                (xii)    Any other similar policies providing for
24          limited benefits.
25      "Insurer."      An entity that offers, issues or renews an
26   individual or group health insurance policy that provides
27   medical or health care coverage by a health care facility or
28   licensed health care provider and that is governed under any of
29   the following:
30          (1)     The act of May 17, 1921 (P.L.682, No.284), known as

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 1    The Insurance Company Law of 1921, including section 630 and
 2    Article XXIV of The Insurance Company Law of 1921.
 3        (2)   The act of December 29, 1972 (P.L.1701, No.364),
 4    known as the Health Maintenance Organization Act.
 5        (3)   40 Pa.C.S. Ch. 61 (relating to hospital plan
 6    corporations).
 7        (4)   40 Pa.C.S. Ch. 63 (relating to professional health
 8    services plan corporations).
 9    "State-mandated health benefit."      As follows:
10        (1)   A benefit that requires a health insurance policy to
11    do any of the following:
12              (i)    Provide coverage or increase the amount of
13        coverage for the treatment of a particular disease,
14        condition or other health care need that exceeds Federal
15        requirements.
16              (ii)    Provide coverage or increase the amount of
17        coverage of equipment, supplies or drugs used in
18        connection with a health care treatment or service that
19        exceed Federal requirements.
20              (iii)    Provide coverage for care delivered by a
21        specific type of provider.
22              (iv)    Require a particular benefit design or impose
23        limitations or restrictions on deductibles, coinsurance,
24        copayments or any annual or lifetime maximum benefit
25        amounts.
26              (v)    Impose limits or conditions on a contract
27        between an insurer and a health care provider.
28        (2)   The term does not include coverage that is mandated
29    by Federal law or amends the scope of practice of a licensed
30    health care professional.

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 1   Section 3.     Mandated health benefit moratorium.
 2      Until submission to the General Assembly of the report
 3   required under section 5, a moratorium is established during
 4   which the General Assembly may not consider or act on any new or
 5   expanded coverage under a health insurance policy.
 6   Section 4.     Construction.
 7      Nothing in this act shall be construed to:
 8            (1)   Prohibit an employer or insurer from electing to
 9      provide new or expanded coverage under a health insurance
10      policy.
11            (2)   Prohibit changes in coverage requirements to comply
12      with Federal law.
13   Section 5.     Report of existing mandated benefits.
14      (a)   Authorization.--The committee shall evaluate State-
15   mandated health benefits and the cost to employers and
16   individuals and shall issue a report to the General Assembly in
17   accordance with this section.
18      (b)   Contents.--The report under this section must contain
19   the following:
20            (1)   A list of each existing State-mandated health
21      benefit placed upon insurers in this Commonwealth.
22            (2)   The fiscal impact of each existing State-mandated
23      health benefit on the premiums for health insurance policy
24      coverage in this Commonwealth.
25            (3)   Whether the existing State-mandated health benefits
26      will result in the Commonwealth being required to make
27      payments to defray the cost under 42 U.S.C. § 18031(d)(3)
28      (relating to affordable choices for health benefit plans) and
29      45 CFR 155.170 (relating to additional required benefits), as
30      amended.

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 1            (4)   The social, financial and medical efficacy of each
 2      State-mandated health benefit.
 3      (c)   Issuance.--Not later than December 31, 2026, the
 4   committee shall submit the report required under this section,
 5   which contains its findings and any recommendations, to:
 6            (1)   The chairperson and minority chairperson of the
 7      Appropriations Committee of the Senate.
 8            (2)   The chairperson and minority chairperson of the
 9      Appropriations Committee of the House of Representatives.
10            (3)   The chairperson and minority chairperson of the
11      Banking and Insurance Committee of the Senate.
12            (4)   The chairperson and minority chairperson of the
13      Insurance Committee of the House of Representatives.
14      (d)   Notice.--Upon the submittal of the report under this
15   section, the committee shall transmit notice of the submittal of
16   the report to the Legislative Reference Bureau for publication
17   in the next available issue of the Pennsylvania Bulletin.
18   Section 6.     Effective date.
19      This act shall take effect immediately.




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