HB 2464 — 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, further providing for coverage of prescriptions; and making editorial changes.

PRINTER'S NO.   3299

                        THE GENERAL ASSEMBLY OF PENNSYLVANIA



                            HOUSE BILL
                            No. 2464
                                                  Session of
                                                    2026

     INTRODUCED BY PARKER, MAYES, WAXMAN, VENKAT, BRENNAN, HILL-
        EVANS, PROBST, SANCHEZ AND NEILSON, APRIL 28, 2026

     REFERRED TO COMMITTEE ON INSURANCE, APRIL 29, 2026


                                       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, further
12      providing for coverage of prescriptions; and making editorial
13      changes.
14      The General Assembly of the Commonwealth of Pennsylvania
15   hereby enacts as follows:
16         Section 1.    Sections 633(d)(1)(i), 635.2(f)(6)(i), 635.4(a)
17   (2)(iii) and 635.6(d)(1) of the act of May 17, 1921 (P.L.682,
18   No.284), known as The Insurance Company Law of 1921, are amended
19   to read:
20         Section 633.    Mastectomy and Breast Cancer Reconstruction.--*
21   * *
22         (d)   (1)   * * *
23         (i)   Subarticle (f) of Article IV of the act of June 13, 1967
 1   (P.L.31, No.21), known as the ["Public Welfare Code."] "Human
 2   Services Code."
 3      * * *
 4      Section 635.2.    Autism Spectrum Disorders Coverage.--* * *
 5      (f)   As used in this section:
 6      * * *
 7      (6)   "Government program" means any of the following:
 8      (i)   The Commonwealth's medical assistance program
 9   established under the act of June 13, 1967 (P.L.31, No.21),
10   known as the ["Public Welfare Code."] "Human Services Code."
11      * * *
12      Section 635.4.    Mini-COBRA Small Employer Group Health
13   Policies.--(a)    A group policy in effect or delivered or issued
14   for delivery in this Commonwealth on or after the effective date
15   of this section by an insurer which insures employes and their
16   eligible dependents for hospital, surgical or major medical
17   insurance shall provide that covered employes, or eligible
18   dependents whose coverage under the group policy would otherwise
19   terminate because of a qualifying event, shall be entitled to
20   continue their hospital, surgical or major medical coverage
21   under that group policy subject to the following terms and
22   conditions:
23      * * *
24      (2)   Continuation shall not be available for any person
25   covered under the group policy who:
26      * * *
27      (iii)   is or could be covered by any other insured or
28   uninsured arrangement which provides hospital, surgical or major
29   medical coverage for individuals in a group and under which the
30   person was not covered immediately prior to such termination,

20260HB2464PN3299                   - 2 -
 1   excluding the medical assistance program established under the
 2   act of June 13, 1967 (P.L.31, No.21), known as the ["Public
 3   Welfare Code,"] "Human Services Code," the children's health
 4   care program established under Article XXIII or the adult basic
 5   coverage insurance program established under Chapter 13 of the
 6   act of June 26, 2001 (P.L.755, No.77), known as the "Tobacco
 7   Settlement Act," and any successors thereto.
 8      * * *
 9      Section 635.6.    Coverage of Prescriptions.--* * *
10      (d)    As used in this section:
11      (1)    "Government program" means any of the following:
12      (i)    The Commonwealth's medical assistance program
13   established under the act of June 13, 1967 (P.L.31, No.21),
14   known as the ["Public Welfare Code."] "Human Services Code."
15      (ii)    The Children's Health Care Program established under
16   Article [XXIII] XXIII-A.
17      (iii)    The program of pharmaceutical assistance for the
18   elderly established under Chapter 5 of the act of August 26,
19   1971 (P.L.351, No.91), known as the "State Lottery Law."
20      * * *
21      Section 2.    The definition of "hospital" in section 601-A of
22   the act is amended to read:
23      Section 601-A.    Definitions.--As used in this article the
24   following words and phrases shall have the meanings given to
25   them in this section:
26      * * *
27      "Hospital."    A facility licensed as a hospital by the
28   Department of Health, the Department of [Public Welfare] Human
29   Services, or operated by the Commonwealth and conducting an
30   alcoholism or drug addiction treatment program licensed by the

20260HB2464PN3299                   - 3 -
 1   Department of Health.
 2      * * *
 3      Section 3.     Section 1110.1(a) and (b) of the act are amended
 4   to read:
 5      Section 1110.1.     Long-Term Care Partnership Program.--(a)
 6   There is hereby established the Long-Term Care Partnership
 7   Program, to be administered by the Department of [Public
 8   Welfare] Human Services in accordance with the requirements for
 9   qualified State long-term care insurance partnerships. The
10   purpose of this program is to reduce future Medicaid costs for
11   long-term care by delaying or eliminating dependence on Medicaid
12   by providing incentives for individuals to ensure against the
13   potentially substantial costs that arise upon the need for long-
14   term care.
15      (b)     In order to implement the program, the Department of
16   [Public Welfare] Human Services shall file a State plan
17   amendment with Centers for Medicare and Medicaid Services of the
18   United States Department of Health and Human Services pursuant
19   to Title XIX of the Social Security Act (49 Stat. 620, 42 U.S.C.
20   § 1396 et seq.) within 30 days of the effective date of this
21   section. The program, including the treatment of assets for
22   Medicaid eligibility and estate recovery, shall be structured
23   and administered by the Department of [Public Welfare] Human
24   Services in accordance with Federal law and applicable Federal
25   guidelines for qualified State long-term care partnerships.
26      * * *
27      Section 4.     The definition of "public health care coverage"
28   in section 1201 of the act is amended to read:
29      Section 1201.     Definitions.--As used in this article, the
30   following words and phrases shall have the meanings given to

20260HB2464PN3299                    - 4 -
 1   them in this section:
 2      * * *
 3      "Public health care coverage."     The State program of medical
 4   assistance established under the act of June 13, 1967 (P.L.31,
 5   No.21), known as the ["Public Welfare Code."] "Human Services
 6   Code."
 7      * * *
 8      Section 5.   Sections 1202(a) and (b) and 1205 of the act are
 9   amended to read:
10      Section 1202.   Forms for Health Insurance Claims.--(a)   Each
11   health insurance claim form processed or otherwise used by an
12   insurer, including those used by the Department of [Public
13   Welfare] Human Services for public health care coverage, shall
14   be the uniform claim form developed by the department. The claim
15   form shall be identical in form and content except as provided
16   in subsection (c). The department shall, in consultation with
17   the Department of [Public Welfare] Human Services, insurers and
18   health care providers or their representatives, first consider
19   the feasibility of utilizing the UB-82/HCFA-1450 and HCFA-1500
20   forms, or their successors, as a uniform claim form. If these
21   forms are deemed to be unsatisfactory, the department shall, in
22   consultation with the Department of [Public Welfare] Human
23   Services, insurers and health care providers or their
24   representatives, develop a uniform claim form for use by all
25   insurers, the Department of [Public Welfare's] Human Services'
26   public health care coverage program and health care providers.
27   The uniform claim form shall contain blank spaces at appropriate
28   places in the document for approved additional information
29   requests under subsection (c).
30      (b)   The feasibility study and subsequent development of the

20260HB2464PN3299                  - 5 -
 1   uniform claim form shall be complete within one hundred eighty
 2   (180) days of the effective date of this article. All insurers,
 3   the Department of [Public Welfare's] Human Services' public
 4   health care coverage program and health care providers shall be
 5   required to use the uniform claim form within one hundred twenty
 6   (120) days after the uniform claim form is developed. The
 7   department may consider a request from the Department of [Public
 8   Welfare] Human Services for an extension in meeting the
 9   implementation schedule of this section.
10      * * *
11      Section 1205.    Federal Compliance.--In the event the Federal
12   Government enacts a uniform claim form for mandatory use by all
13   insurers and the Department of [Public Welfare's] Human
14   Services' public health care coverage program, the department
15   shall adopt the Federal form for use by all insurers, the
16   Department of [Public Welfare's] Human Services' public health
17   care coverage program and health care providers within ninety
18   (90) days of the enactment of the Federal legislation or the
19   effective date included in the Federal act, whichever is later.
20      Section 6.     The definition of "medical assistance" in section
21   2301-A of the act is amended to read:
22   Section 2301-A.    Definitions.
23      The following words and phrases when used in this article
24   shall have the meanings given to them in this section unless the
25   context clearly indicates otherwise:
26      * * *
27      "Medical assistance."    The State program of medical
28   assistance established under the act of June 13, 1967 (P.L.31,
29   No.21), known as the [Public Welfare] Human Services Code.
30      * * *

20260HB2464PN3299                      - 6 -
 1      Section 7.     Sections 2302-A(d)(5) and (e)(2) and 2304-A(a)(3)
 2   (iv) of the act are amended to read:
 3   Section 2302-A.        Children's health care.
 4      * * *
 5      (d)   Income levels.--The provision of health care insurance
 6   for eligible children shall be in accordance with the following:
 7            * * *
 8            (5)   Notwithstanding paragraphs (1), (2), (3) and (4),
 9      for purposes of determining cost-sharing obligations of a
10      family with income levels specified under paragraphs (2), (3)
11      and (4), the per member per month premium shall exclude the
12      cost related to an assessment imposed on a contractor
13      relating to managed care organization assessments under the
14      act of June 13, 1967 (P.L.31, No.21), known as the [Public
15      Welfare] Human Services Code.
16      (e)   Income exceeding limits.--The following apply:
17            * * *
18            (2)   For purposes of this subsection, the per member per
19      month premium cost shall exclude the cost related to the
20      managed care organization assessment imposed on a contractor
21      under the [Public Welfare] Human Services Code.
22            * * *
23   Section 2304-A.        Contracts and coverage packages.
24      (a)   Paid from fund.--In addition to any other requirements
25   provided by law, the fund shall be operated in accordance with
26   the following:
27            * * *
28            (3)   The department must award contracts paid from the
29      fund in accordance with the following:
30                  * * *

20260HB2464PN3299                       - 7 -
 1             (iv)   In determining the amount of the contract which
 2        may be used for the purposes specified in subparagraphs
 3        (ii) and (iii), any Federal and State taxes that would be
 4        deducted from premium revenue in determining an issuer's
 5        medical loss ratio under 45 CFR 158.221 (relating to
 6        formula for calculating an issuer's medical loss ratio),
 7        including a managed care organization assessment imposed
 8        on a contractor under the act of June 13, 1967 (P.L.31,
 9        No.21), known as the [Public Welfare] Human Services
10        Code, shall be excluded.
11    * * *
12    Section 8.    This act shall take effect immediately.




20260HB2464PN3299                 - 8 -