HB 839 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for continuity of care.

PRINTER'S NO.     869

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 839
                                               Session of
                                                 2025

     INTRODUCED BY WEBSTER, SANCHEZ, HILL-EVANS, MADDEN, PIELLI,
        MAYES AND CERRATO, MARCH 10, 2025

     REFERRED TO COMMITTEE ON INSURANCE, MARCH 10, 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 quality health care
12      accountability and protection, further providing for
13      continuity of care.
14      The General Assembly of the Commonwealth of Pennsylvania
15   hereby enacts as follows:
16      Section 1.    Section 2117(a), (c) and (d) of the act of May
17   17, 1921 (P.L.682, No.284), known as The Insurance Company Law
18   of 1921, are amended and the section is amended by adding a
19   subsection to read:
20      Section 2117.    Continuity of Care.--(a)   Except as provided
21   under subsection (b), if an insurer or MA or CHIP managed care
22   plan initiates termination of its contract with a participating
23   health care provider, or if a participating health care provider
 1   initiates termination of its contract, with an insurer or MA or
 2   CHIP managed care plan, or if the contract expires or is
 3   nonrenewed by either party, a covered person or enrollee may
 4   continue an ongoing course of treatment with that health care
 5   provider at the covered person's or enrollee's option for a
 6   transitional period of up to [sixty (60)] one hundred twenty
 7   (120) days from the date the covered person or enrollee was
 8   notified by the insurer or MA or CHIP managed care plan of the
 9   termination or pending termination, expiration or nonrenewal.
10   The insurer or MA or CHIP managed care plan, in consultation
11   with the covered person or enrollee and the health care
12   provider, may extend the transitional period if determined to be
13   clinically appropriate. In the case of a covered person or
14   enrollee in the second or third trimester of pregnancy at the
15   time of notice of the termination or pending termination, the
16   transitional period shall extend through postpartum care related
17   to the delivery. Any health care service provided under this
18   section shall be covered by the insurer or MA or CHIP managed
19   care plan under the same terms and conditions as applicable for
20   participating health care providers.
21      * * *
22      (c)   If an insurer or MA or CHIP managed care plan terminates
23   the contract of a participating primary care provider, or if a
24   participating health care provider terminates its contract with
25   an insurer or MA or CHIP managed care plan, or if the contract
26   expires or is nonrenewed by either party, the insurer or MA or
27   CHIP managed care plan shall notify every covered person or
28   enrollee served by that provider of [insurer's or MA or CHIP
29   managed care plan's termination of its contract] the change in
30   the provider's network status and shall request that the covered

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 1   person or enrollee select another primary care provider.
 2      (d)   A new covered person or enrollee may continue an ongoing
 3   course of treatment with a nonparticipating health care provider
 4   for a transitional period of up to [sixty (60)] one hundred
 5   twenty (120) days from the effective date of enrollment in a
 6   health insurance policy or MA or CHIP managed care plan. The
 7   insurer or MA or CHIP managed care plan, in consultation with
 8   the covered person or enrollee and the health care provider, may
 9   extend this transitional period if determined to be clinically
10   appropriate. In the case of a new covered person or enrollee in
11   the second or third trimester of pregnancy on the effective date
12   of enrollment, the transitional period shall extend through
13   postpartum care related to the delivery. Any health care service
14   provided under this section shall be covered by the health
15   insurance policy or MA or CHIP managed care plan under the same
16   terms and conditions as applicable for participating health care
17   providers.
18      * * *
19      (g)   Where an insurer or MA or CHIP managed care plan has
20   reimbursed a nonparticipating health care provider for services
21   provided during the transitional period provided for under
22   subsection (a) or (d) at the same rate the insurer or MA or CHIP
23   managed care plan has established for a participating health
24   care provider, the nonparticipating health care provider may not
25   bill the covered person or enrollee directly or indirectly or
26   otherwise attempt to collect from the covered person or enrollee
27   for the service provided, except for a billing to recover cost
28   sharing at the rate established for services provided by
29   participating health care providers, as specified in the health
30   insurance policy or MA or CHIP managed care plan.

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 1    Section 2.    The following shall apply:
 2        (1)   For a health insurance policy for which either rates
 3    or forms are required to be filed with the Federal Government
 4    or the Insurance Department, this act shall apply to any
 5    policy for which a form or rate is first filed on or after
 6    180 days after the effective date of this paragraph.
 7        (2)   For health insurance policies for which neither
 8    rates nor forms are required to be filed with the Federal
 9    Government or the Insurance Department, this act shall apply
10    to any policy issued or renewed on or after 180 days after
11    the effective date of this paragraph.
12    Section 3.    This act shall take effect in 60 days.




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