HB 755 — An Act providing for health care insurance preventive services coverage protections; conferring authority on the Insurance Department and the Insurance Commissioner; and providing for regulations, for enforcement and for penalties.

PRINTER'S NO.   779

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 755
                                               Session of
                                                 2025

     INTRODUCED BY WARREN, PIELLI, VENKAT, OTTEN, SANCHEZ, KHAN,
        PROKOPIAK, GIRAL, FREEMAN, HANBIDGE, HOHENSTEIN, DONAHUE,
        GALLAGHER, SCHLOSSBERG, HOWARD, SHUSTERMAN, DALEY, DEASY,
        FIEDLER, MADDEN AND MALAGARI, MARCH 3, 2025

     REFERRED TO COMMITTEE ON INSURANCE, MARCH 3, 2025


                                    AN ACT
 1   Providing for health care insurance preventive services coverage
 2      protections; conferring authority on the Insurance Department
 3      and the Insurance Commissioner; and providing for
 4      regulations, for enforcement and for penalties.
 5      The General Assembly of the Commonwealth of Pennsylvania
 6   hereby enacts as follows:
 7   Section 1.   Short title.
 8      This act shall be known and may be cited as the Health
 9   Insurance Preventive Services Coverage Act.
10   Section 2.   Definitions.
11      The following words and phrases when used in this act shall
12   have the meanings given to them in this section unless the
13   context clearly indicates otherwise:
14      "Commissioner."    The Insurance Commissioner of the
15   Commonwealth.
16      "Cost sharing."    The share of health care costs covered by an
17   insurance policy that an enrollee pays out-of-pocket. The term
18   includes deductibles, coinsurance, copayments and similar
 1   charges. The term does not include a premium, a balance billed
 2   amount from an out-of-network provider or the cost of a
 3   noncovered service.
 4      "Department."   The Insurance Department of the Commonwealth.
 5      "Enrollee."   A policyholder, subscriber, covered person or
 6   other individual who is entitled to receive health care services
 7   under a health insurance policy.
 8      "Grandfathered health care plan."      Individual or group health
 9   insurance coverage in which an individual was enrolled prior to
10   March 23, 2010, or as specified in 42 U.S.C. § 18011 (relating
11   to preservation of right to maintain existing coverage).
12      "Health insurance policy."    A policy, subscriber contract,
13   certificate or plan issued by an insurer that provides medical
14   or health care coverage. The term does not include any of the
15   following:
16          (1)    An accident only policy.
17          (2)    A credit only policy.
18          (3)    A long-term care or disability income policy.
19          (4)    A specified disease policy.
20          (5)    A Medicare supplement policy.
21          (6)    A fixed indemnity policy.
22          (7)    A dental only policy.
23          (8)    A vision only policy.
24          (9)    A workers' compensation policy.
25          (10)    An automobile medical payment policy.
26          (11)    A policy under which benefits are provided by the
27      Federal Government to active or former military personnel and
28      their dependents.
29          (12)    A hospital indemnity policy.
30          (13)    Any other similar policy providing for limited

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 1      benefits.
 2      "Insurer."    An entity that offers, issues or renews a health
 3   insurance policy that provides medical or health care coverage
 4   by a health care facility or licensed health care provider and
 5   that is governed under any of the following:
 6          (1)     The act of May 17, 1921 (P.L.682, No.284), known as
 7      The Insurance Company Law of 1921, including section 630 and
 8      Article XXIV of that act.
 9          (2)     The act of December 29, 1972 (P.L.1701, No.364),
10      known as the Health Maintenance Organization Act.
11          (3)     40 Pa.C.S. Ch. 61 (relating to hospital plan
12      corporations).
13          (4)     40 Pa.C.S. Ch. 63 (relating to professional health
14      services plan corporations).
15      "Out-of-network provider."    A provider who does not contract
16   with an insurer to provide health care services to an enrollee
17   under a health insurance policy.
18      "Preventive service."    A health care service that is on the
19   preventive services list.
20      "Preventive services list."     A list of health care services
21   compiled by the department that includes:
22          (1)     Health care services required to be covered by an
23      individual health insurance policy approved to be offered or
24      issued in this Commonwealth on January 1, 2025, as a
25      preventive service in accordance with 42 U.S.C. § 300gg-13
26      (relating to coverage of preventive health services), other
27      than any health care service exempted by the department under
28      the modification process under section 4.
29          (2)     Health care services added by the department under
30      the modification process under section 4.

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 1   Section 3.     Preventive services coverage requirement.
 2      An insurer offering, issuing or renewing a health insurance
 3   policy other than a grandfathered health care plan shall provide
 4   coverage and may not impose any cost-sharing requirements for
 5   services on the preventive services list.
 6   Section 4.     Modification of preventive services list.
 7      (a)     Additions and exemptions.--The department may add or
 8   exempt one or more preventive services from the preventive
 9   services list in accordance with the requirements of this
10   section.
11      (b)     Notice and comment requirements.--Prior to adopting an
12   addition to or exemption from the preventive services list, the
13   department shall:
14            (1)   Transmit a notice to the Legislative Reference
15      Bureau for publication in the next available issue of the
16      Pennsylvania Bulletin requesting public comments. The public
17      comment period shall be for not less than 15 business days
18      following the date of publication.
19            (2)   Post the notice on the department's publicly
20      accessible Internet website.
21            (3)   Electronically send the notice to the chairperson
22      and minority chairperson of the Banking and Insurance
23      Committee of the Senate and the chairperson and minority
24      chairperson of the Insurance Committee of the House of
25      Representatives.
26      (c)     Evaluation standards.--
27            (1)   The department may add a service to the preventive
28      service list if the department finds that the service is
29      then-currently:
30                  (i)   An evidence-based item or service that has in

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 1        effect a rating of "A" or "B" by the United States
 2        Preventive Services Task Force.
 3              (ii)    A recommended immunization by the Advisory
 4        Committee on Immunization Practices of the Centers for
 5        Disease Control and Prevention.
 6              (iii)    A preventive care or screening for women,
 7        infants, children or adolescents provided for in the
 8        comprehensive guidelines supported by the United States
 9        Health Resources and Services Administration.
10        (2)   The department may exempt a service from the
11    preventive services list if the service no longer meets the
12    requirements of paragraph (1).
13        (3)   In addition to the requirements of paragraphs (1)
14    and (2), prior to adopting an addition or exemption of a
15    service from the preventive services list, the department
16    shall consider:
17              (i)    Each public comment received in response to the
18        notice under subsection (b).
19              (ii)    The potential escalation of the cost of health
20        care services.
21              (iii)    The accessibility and cost of the preventive
22        service and of health care services likely to be avoided
23        by the preventive service.
24              (iv)    Changes in medical evidence or scientific
25        advancement.
26              (v)    The potential for discrimination against
27        individuals by reason of:
28                     (A)   Health status-related factors listed under
29              42 U.S.C. § 300gg-4 (relating to prohibiting
30              discrimination against individual participants and

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 1                  beneficiaries based on health status).
 2                      (B)   The factors specified in section 5(a)(7)
 3                  (iii) of the act of July 22, 1974 (P.L.589, No.205),
 4                  known as the Unfair Insurance Practices Act.
 5                      (C)   The expected length of life, present or
 6                  predicted disability, degree of medical dependency or
 7                  quality of life.
 8      (d)   Maintenance of list.--Each time a benefit is added or
 9   exempted from the preventive services list, the department shall
10   transmit notice of the addition or exemption to the Legislative
11   Reference Bureau for publication in the next available issue of
12   the Pennsylvania Bulletin and shall post and transmit the notice
13   in the same manner as the preliminary notice under subsection
14   (b)(2) and (3). The department shall maintain a current
15   preventive services list on the department's publicly accessible
16   Internet website.
17      (e)   Applicability.--An addition or exemption under
18   subsection (a) shall apply as follows:
19            (1)   For a health insurance policy for which either rates
20      or forms are required to be filed with the department, to a
21      policy for which a form or rate is first filed on or after
22      the notice.
23            (2)   For a health insurance policy for which neither
24      rates nor forms are required to be filed with the department,
25      to a policy issued or renewed 180 days after the publication
26      of the notice.
27            (3)   For an exemption of a service on the grounds of a
28      potential danger to patients, on a case-by-case basis, at a
29      time established by the department within the time provided
30      in paragraphs (1) and (2).

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 1      (f)   Administrative procedure.--An addition or exemption by
 2   the department is appealable to the commissioner under 1 Pa.
 3   Code 35.20 (relating to appeals from actions of the staff) and
 4   shall be subject to 2 Pa.C.S. Ch. 5 Subch. A (relating to
 5   practice and procedure of Commonwealth agencies). A party may
 6   appeal the commissioner's adjudication to Commonwealth Court as
 7   provided in 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial
 8   review of Commonwealth agency action).
 9   Section 5.     Construction.
10      (a)   Construction.--Nothing in this act shall be construed to
11   prohibit an insurer from:
12            (1)   Providing coverage for preventive services in
13      addition to those on the preventive services list.
14            (2)   Denying coverage for preventive services not on the
15      preventive services list.
16            (3)   Using value-based insurance designs.
17            (4)   Using reasonable medical management techniques to
18      determine the frequency, method, treatment or setting for a
19      preventive service, based on relevant clinical evidence, to
20      the extent not specified in the relevant recommendation or
21      guideline.
22            (5)   Diminish any other law that limits cost sharing for
23      a health care service.
24      (b)   Insurers.--For an insurer that uses a network of
25   providers to provide services under a health insurance policy:
26            (1)   Subject to paragraph (2), nothing in this act shall
27      be construed to:
28                  (i)   Require the insurer to provide coverage for
29            services on the preventive services list that are
30            delivered by an out-of-network provider.

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 1                  (ii)   Preclude the insurer from imposing cost-sharing
 2            requirements for services on the preventive services list
 3            that are delivered by an out-of-network provider.
 4            (2)   If an insurer does not have in its network a
 5      provider who can provide an item or service on the preventive
 6      services list, the insurer shall cover the item or service
 7      when performed by an out-of-network provider and may not
 8      impose cost-sharing with respect to the item or service.
 9      (c)   Health insurance policies.--Nothing in this act shall
10   require a health insurance policy to cover a preventive service
11   if the enrollee is exempt by the exercise of its constitutional
12   protections of religious freedom under the act of December 9,
13   2002 (P.L.1701, No.214), known as the Religious Freedom
14   Protection Act, or 42 U.S.C. Ch. 21B (relating to religious
15   freedom restoration).
16   Section 6.     Regulations.
17      The department may promulgate regulations as may be necessary
18   and appropriate to carry out the provisions of this act.
19   Section 7.     Enforcement.
20      (a)   Penalties.--Upon satisfactory evidence of the violation
21   of any section of this act by an insurer or any other person,
22   one or more of the following penalties may be imposed at the
23   commissioner's discretion:
24            (1)   Suspension or revocation of the license of the
25      offending insurer or other person.
26            (2)   Refusal, for a period not to exceed one year, to
27      issue a new license to the offending insurer or other person.
28            (3)   A fine of not more than $5,000 for each violation of
29      this act.
30            (4)   A fine of not more than $10,000 for each willful

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 1      violation of this act.
 2      (b)   Limitations.--
 3            (1)   Fines imposed against an individual insurer under
 4      this act may not exceed $500,000 in the aggregate during a
 5      single calendar year.
 6            (2)   Fines imposed against any other person under this
 7      act may not exceed $100,000 in the aggregate during a single
 8      calendar year.
 9      (c)   Additional remedies.--The enforcement remedies imposed
10   under this subsection are in addition to any other remedies or
11   penalties that may be imposed under any other applicable law of
12   this Commonwealth, including:
13            (1)   The act of July 22, 1974 (P.L.589, No.205), known as
14      the Unfair Insurance Practices Act. Violations of this act
15      shall be deemed to be an unfair method of competition and an
16      unfair or deceptive act or practice under the Unfair
17      Insurance Practices Act.
18            (2)   The act of December 18, 1996 (P.L.1066, No.159),
19      known as the Accident and Health Filing Reform Act.
20            (3)   The act of June 25, 1997 (P.L.295, No.29), known as
21      the Pennsylvania Health Care Insurance Portability Act.
22      (d)   Administrative procedure.--The administrative provisions
23   of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
24   (relating to practice and procedure of Commonwealth agencies). A
25   party against whom penalties are assessed in an administrative
26   action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
27   Ch. 7 Subch. A (relating to judicial review of Commonwealth
28   agency action).
29   Section 8.     Repeals.
30      All acts and parts of acts are repealed insofar as they are

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 1   inconsistent with this act.
 2   Section 9.    Implementation notice.
 3      The commissioner shall transmit notice to the Legislative
 4   Reference Bureau for publication in the next available issue of
 5   the Pennsylvania Bulletin if any of the following occur:
 6          (1)    The Congress of the United States repeals, in whole
 7      or in part, 42 U.S.C. § 300gg-13 (relating to coverage of
 8      preventive health services).
 9          (2)    A court of the United States with competent
10      jurisdiction abrogates, vacates or invalidates, in whole or
11      in part, 42 U.S.C. § 300gg-13.
12          (3)    The executive branch of the United States refuses to
13      enforce, or repeals a regulation implementing, in whole or in
14      part, 42 U.S.C. § 300gg-13.
15   Section 10.    Implementation.
16      The implementation of this act shall be limited to the
17   provisions necessary to achieve a substitute coverage
18   requirement for the portion or portions of 42 U.S.C. § 300gg-13
19   (relating to coverage of preventive health services) that are
20   impacted by the occurrence of any of the events described in
21   section 9.
22   Section 11.    Effective date.
23      This act shall take effect as follows:
24          (1)    The following shall take effect immediately:
25                 Section 9.
26                 Section 10.
27                 This section.
28          (2)    The remainder of this act shall take effect upon
29      publication of the implementation notice in section 9.



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