HB 1346 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for menopause treatment coverage.

PRINTER'S NO.   1585

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 1346
                                               Session of
                                                 2025

     INTRODUCED BY HANBIDGE, CEPHAS, HILL-EVANS, FREEMAN, WAXMAN,
        GUENST, OTTEN, PIELLI, PARKER, SANCHEZ, K.HARRIS, HOHENSTEIN,
        CEPEDA-FREYTIZ, D. WILLIAMS AND O'MARA, MAY 5, 2025

     REFERRED TO COMMITTEE ON INSURANCE, MAY 5, 2025


                                    AN ACT
 1   Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
 2      act relating to insurance; amending, revising, and
 3      consolidating the law providing for the incorporation of
 4      insurance companies, and the regulation, supervision, and
 5      protection of home and foreign insurance companies, Lloyds
 6      associations, reciprocal and inter-insurance exchanges, and
 7      fire insurance rating bureaus, and the regulation and
 8      supervision of insurance carried by such companies,
 9      associations, and exchanges, including insurance carried by
10      the State Workmen's Insurance Fund; providing penalties; and
11      repealing existing laws," in casualty insurance, providing
12      for menopause treatment coverage.
13      The General Assembly of the Commonwealth of Pennsylvania
14   hereby enacts as follows:
15      Section 1.    The act of May 17, 1921 (P.L.682, No.284), known
16   as The Insurance Company Law of 1921, is amended by adding a
17   section to read:
18      Section 635.11.    Menopause Treatment Coverage.--(a)   A health
19   insurance policy offered, issued or renewed in this Commonwealth
20   shall provide coverage for hormonal and non-hormonal treatments
21   for the management of menopausal symptoms. Coverage required
22   under this section shall include all of the following:
 1      (1)    Coverage for all drugs, devices and combination products
 2   approved by the United States Food and Drug Administration for
 3   the treatment of menopausal symptoms.
 4      (2)    Coverage for behavioral therapy that assists individuals
 5   in coping with menopausal symptoms.
 6      (3)    Coverage for therapy to treat menopause that has been
 7   induced by a hysterectomy.
 8      (b)    Coverage required under this section shall be subject to
 9   the terms and conditions of a health insurance policy, including
10   provisions relating to medical necessity, cost-sharing and
11   utilization review.
12      (c)    As used in this section, the following words and phrases
13   shall have the meanings given to them in this subsection unless
14   the context clearly indicates otherwise:
15      "Cost-sharing" means:
16      (1)    The share of health care costs covered by a health
17   insurance policy that an enrollee or covered person pays out of
18   pocket.
19      (2)    The term includes a deductible, coinsurance, copayment
20   or similar charge.
21      (3)    The term does not include a premium, a balanced bill
22   amount for an out-of-network provider or the cost of a
23   noncovered service.
24      "Health insurance policy" means:
25      (1)    A policy, subscriber contract, certificate or plan that
26   provides medical or health care coverage on an expense-incurred
27   or prepaid basis and that is offered by or is governed under any
28   of the following:
29      (i)    This act, including section 630.
30      (ii)    The act of December 29, 1972 (P.L.1701, No.364), known

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 1   as the "Health Maintenance Organization Act."
 2      (iii)     40 Pa.C.S. Chs. 61 (relating to hospital plan
 3   corporations) and 63 (relating to professional health services
 4   plan corporations).
 5      (2)    The term does not include any of the following:
 6      (i)    An accident only policy.
 7      (ii)     A credit only policy.
 8      (iii)     A long-term care or disability income policy.
 9      (iv)     A specified disease policy.
10      (v)    A Medicare supplement policy.
11      (vi)     A TRICARE policy, including a Civilian Health and
12   Medical Program of the Uniformed Services (CHAMPUS) supplement
13   policy.
14      (vii)     A fixed indemnity policy.
15      (viii)     A hospital indemnity policy.
16      (ix)     A dental only policy.
17      (x)    A vision only policy.
18      (xi)     A workers' compensation policy.
19      (xii)     An automobile medical payment policy issued under 75
20   Pa.C.S. (relating to vehicles).
21      (xiii)     A homeowners' insurance policy.
22      (xiv)     Any other similar policy providing for limited
23   benefits.
24      "Hysterectomy" means a surgical procedure to remove a woman's
25   uterus, which may include removal of the cervix, ovaries or
26   fallopian tubes.
27      "Menopausal symptoms" means any of the following:
28      (1)    Irregular menstrual periods.
29      (2)    Hot flashes.
30      (3)    Vaginal or bladder changes.

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 1      (4)   Decreased fertility.
 2      (5)   Loss of bone density, including osteoporosis.
 3      (6)   Elevated low-density lipoprotein cholesterol levels.
 4      (7)   Sleep disturbances, including night sweats.
 5      "Menopause" means the permanent cessation of menstruation
 6   resulting from loss of ovarian follicular function,
 7   characterized by the end of ovulation and a decline in estrogen
 8   and progesterone production.
 9      Section 2.    This act shall apply as follows:
10            (1)   For a health insurance policy for which either rates
11      or forms are required to be filed with the Insurance
12      Department, the addition of section 635.11 of the act shall
13      apply to a policy for which a form or rate is first filed on
14      or after the effective date of this paragraph.
15            (2)   For a health insurance policy for which neither
16      rates nor forms are required to be filed with the Insurance
17      Department, the addition of section 635.11 of the act shall
18      apply to a policy issued or renewed on or after 180 days
19      after the effective date of this paragraph.
20      Section 3.    This act shall take effect in 60 days.




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