Bill Summary – FastDemocracy

PRINTER'S NO.   3528
                     THE GENERAL ASSEMBLY OF PENNSYLVANIA
                         HOUSE BILL
                         No. 2510
                                                 Session of
                                                   2024
     INTRODUCED BY MUNROE, KHAN, FRANKEL, BIZZARRO, PROBST, GIRAL,
        SANCHEZ, VENKAT, HILL-EVANS, KINSEY, RABB, PIELLI,
        SCHLOSSBERG, KIM, MERSKI, DONAHUE, BOROWSKI, WAXMAN,
        KENYATTA, O'MARA, FLEMING, ROZZI, SHUSTERMAN, POWELL, STEELE,
        CIRESI, CEPEDA-FREYTIZ, KAZEEM AND PASHINSKI, JULY 23, 2024
     REFERRED TO COMMITTEE ON INSURANCE, JULY 23, 2024
                                     AN ACT
 Providing for individual and group health care insurance
    coverage protections and for core health benefits; imposing
    penalties; and providing for applicability and for
    regulations.
    The General Assembly of the Commonwealth of Pennsylvania
 hereby enacts as follows:
 Section 1.   Short title.
    This act shall be known and may be cited as the Health
 Insurance Core Benefits Coverage Act.
 Section 2.   Definitions.
    The following words and phrases when used in this act shall
 have the meanings given to them in this section unless the
 context clearly indicates otherwise:
    "Commissioner."     The Insurance Commissioner of the
 Commonwealth.
    "Department."     The Insurance Department of the Commonwealth.
    "Group health insurance policy."      A policy, subscriber
 contract, certificate or plan issued by an insurer that provides
 medical or health care coverage on an annual basis to
 individuals who obtain health insurance coverage through a
 group.
    "Health insurance policy."     A policy, subscriber contract,
 certificate or plan issued by an insurer that provides medical
 or health care coverage. The term does not include any of the
 following:
          (1)    An accident only policy.
          (2)    A credit only policy.
          (3)    A long-term care or disability income policy.
          (4)    A specified disease policy.
          (5)    A Medicare supplement policy.
          (6)    A fixed indemnity policy.
          (7)    A dental only policy.
          (8)    A vision only policy.
          (9)    A workers' compensation policy.
          (10)    An automobile medical payment policy.
          (11)    A policy under which benefits are provided by the
    Federal Government to active or former military personnel and
    their dependents.
          (12)    Any other similar policies providing for limited
    benefits.
    "Individual health insurance policy."        A policy, subscriber
 contract, certificate or plan issued by an insurer that provides
 medical or health care coverage on an annual basis to an
 individual other than in connection with a group.
    "Insurer."     An entity that offers, issues or renews an
 individual or group health insurance policy, contract or plan
 that provides medical or health care coverage by a health care
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 facility or licensed health care provider and that is governed
 under any of the following:
          (1)    The act of May 17, 1921 (P.L.682, No.284), known as
    The Insurance Company Law of 1921, including section 630 and
    Article XXIV thereof.
          (2)    The act of December 29, 1972 (P.L.1701, No.364),
    known as the Health Maintenance Organization Act.
          (3)    40 Pa.C.S. Ch. 61 (relating to hospital plan
    corporations).
          (4)    40 Pa.C.S. Ch. 63 (relating to professional health
    services plan corporations).
 Section 3.      Core health benefits.
    (a)   Benefits.--Except as otherwise provided in this section,
 an insurer offering, issuing or renewing an individual health
 insurance policy or group health insurance policy shall include
 health benefits in at least the following general categories and
 the items and services covered within the categories:
          (1)    Ambulatory patient services.
          (2)    Emergency services.
          (3)    Hospitalization.
          (4)    Maternity and newborn care.
          (5)    Mental health and substance use disorder services,
    including behavioral health treatment.
          (6)    Prescription drugs.
          (7)    Rehabilitative and habilitative services and
    devices.
          (8)    Laboratory services.
          (9)    Preventive and wellness services and chronic disease
    management.
          (10)    Pediatric services, including oral and vision care.
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    (b)   Comprehensiveness.--
          (1)   An individual health insurance policy or group
    health insurance policy shall cover health benefits at least
    as comprehensive as the health benefits required to be
    covered in an individual health insurance policy or a small
    group policy first offered or issued in this Commonwealth in
    2020.
          (2)   A large group health insurance policy also shall
    cover health benefits required to be covered in a large group
    policy first offered or issued in this Commonwealth in 2020.
    (c)   Modifications.--The department may add a health benefit
 or exempt a health benefit required to be covered under this
 section through a regulation promulgated under section 4. In
 determining whether to add a health benefit or exempt a health
 benefit required to be covered under this section, the
 department shall consider all of the following:
          (1)   The balance of the health benefits in the categories
    specified under subsection (a) and whether the health
    benefits are not unduly weighted toward any category.
          (2)   The health care needs of the diverse segments of the
    population, including women, children, individuals with
    disabilities and other diverse groups.
          (3)   The potential for discrimination against individuals
    because of their age or expected length of life, present or
    predicted disability, degree of medical dependency, quality
    of life or other health conditions.
          (4)   The accessibility of the health benefits, including
    the cost of the health benefits.
          (5)   Changes in medical evidence or scientific
    advancement.
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    (d)   Management techniques.--Nothing in this section shall be
 construed to prevent an insurer from appropriately utilizing
 reasonable medical management techniques.
 Section 4.      Regulations.
    (a)   Authority to promulgate.--The department may promulgate
 regulations as may be necessary and appropriate to carry out the
 provisions of this act.
    (b)   Temporary regulations.--
          (1)    Notwithstanding any other provision of law, in order
    to facilitate the prompt implementation of this act, the
    department may issue temporary regulations which shall expire
    no later than two years following publication of the
    temporary regulations in the Pennsylvania Bulletin. The
    temporary regulations shall be exempt from the following:
                 (i)    Section 612 of the act of April 9, 1929
          (P.L.177, No.175), known as The Administrative Code of
          1929.
                 (ii)    Sections 201, 202, 203, 204 and 205 of the act
          of July 31, 1968 (P.L.769, No.240), referred to as the
          Commonwealth Documents Law.
                 (iii)    Section 204(b) of the act of October 15, 1980
          (P.L.950, No.164), known as the Commonwealth Attorneys
          Act.
                 (iv)    The act of June 25, 1982 (P.L.633, No.181),
          known as the Regulatory Review Act.
          (2)    The authority of the department to issue temporary
    regulations under this subsection shall expire two years from
    the effective date of this paragraph. Regulations adopted
    after the two-year period shall be promulgated as provided by
    statute.
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 Section 5.     Enforcement.
    (a)   General rule.--Upon satisfactory evidence of the
 violation of any section of this act by an insurer or any other
 person, one or more of the following penalties may be imposed at
 the commissioner's discretion:
          (1)   Suspension or revocation of the license of the
    offending insurer or other person.
          (2)   Refusal, for a period not to exceed one year, to
    issue a new license to the offending insurer or other person.
          (3)   A fine of not more than $5,000 for each violation of
    this act.
          (4)   A fine of not more than $10,000 for each willful
    violation of this act.
    (b)   Limitations.--
          (1)   Fines imposed against an individual insurer under
    this act may not exceed $500,000 in the aggregate during a
    single calendar year.
          (2)   Fines imposed against any other person under this
    act may not exceed $100,000 in the aggregate during a single
    calendar year.
    (c)   Additional remedies.--The enforcement remedies imposed
 under this section are in addition to any other remedies or
 penalties that may be imposed under any other applicable law of
 this Commonwealth, including:
          (1)   The act of July 22, 1974 (P.L.589, No.205), known as
    the Unfair Insurance Practices Act. Violations of this act
    shall be deemed to be an unfair method of competition and an
    unfair or deceptive act or practice under the Unfair
    Insurance Practices Act.
          (2)   The act of December 18, 1996 (P.L.1066, No.159),
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    known as the Accident and Health Filing Reform Act.
          (3)   The act of June 25, 1997 (P.L.295, No.29), known as
    the Pennsylvania Health Care Insurance Portability Act.
    (d)   Administrative procedure.--The administrative provisions
 of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
 (relating to practice and procedure of Commonwealth agencies).
 A party against whom penalties are assessed in an administrative
 action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
 Ch. 7 Subch. A (relating to judicial review of Commonwealth
 agency action).
 Section 6.     Applicability.
    This act shall apply as follows:
          (1)   For health insurance policies for which either rates
    or forms are required to be filed with the department, this
    act shall apply to any policy for which a form or rate is
    first filed on or after the effective date of this section.
          (2)   For health insurance policies for which neither
    rates nor forms are required to be filed with the department,
    this act shall apply to any policy issued or renewed on or
    after 180 days after the effective date of this section.
 Section 7.     Repeals.
    All acts and parts of acts are repealed insofar as they are
 inconsistent with this act.
 Section 8.     Effective date.
    This act shall take effect immediately.
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