SB 268 — 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 cost-sharing calculation.

PRINTER'S NO.   221

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                        SENATE BILL
                        No. 268
                                               Session of
                                                 2025

     INTRODUCED BY J. WARD, COLLETT, BROOKS, PENNYCUICK, FONTANA,
        BARTOLOTTA, COMITTA, KEARNEY, TARTAGLIONE, SCHWANK,
        SANTARSIERO AND FARRY, FEBRUARY 20, 2025

     REFERRED TO BANKING AND INSURANCE, FEBRUARY 20, 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 cost-sharing calculation.
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 631.2.    Cost-Sharing Calculation.--(a)    When
19   calculating an insured's contribution to an applicable cost-
20   sharing requirement under a health insurance policy:
21      (1)   The insurer shall include any cost-sharing amounts paid
22   by the insured or on behalf of the insured by another person.
 1      (2)    A pharmacy benefits manager that administers pharmacy
 2   benefits for the insurer shall include any cost-sharing amounts
 3   paid by the insured or on behalf of the insured by another
 4   person.
 5      (b)    This section shall apply to a health insurance policy
 6   issued or entered into or renewed on or after the effective date
 7   of this section.
 8      (c)    As used in this section:
 9      "Cost-sharing" means the cost to an individual insured under
10   a health insurance policy according to a coverage limit,
11   copayment, coinsurance, deductible or other out-of-pocket
12   expense requirements imposed by the policy, contract or
13   agreement.
14      "Covered entity" means a contract holder or policy holder
15   providing pharmacy benefits to a covered individual under a
16   health insurance policy pursuant to a contract administered by a
17   pharmacy benefits manager.
18      "Health insurance policy" means:
19      (1)    An individual or group health, sickness or accident
20   policy, or subscriber contract or certificate offered, issued or
21   renewed by an entity subject to one of the following:
22      (i)    This act.
23      (ii)    The act of December 29, 1972 (P.L.1701, No.364), known
24   as the "Health Maintenance Organization Act."
25      (iii)     40 Pa.C.S. Ch. 61 (relating to hospital plan
26   corporations) or 63 (relating to professional health services
27   plan corporations).
28      (2)    The term does not include accident only, fixed
29   indemnity, hospital indemnity, limited benefit, credit, dental,
30   vision, specified disease, Medicare supplement, Civilian Health

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1   and Medical Program of the Uniformed Services (CHAMPUS)
2   supplement, long-term care or disability income, workers'
3   compensation or automobile medical payment insurance.
4      "Pharmacy benefits manager" means a person, business or other
5   entity that performs pharmacy benefits management for covered
6   entities.
7      Section 2.   This act shall take effect in 60 days.




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