HB 1828 — An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for immunization coverage; and imposing penalties.

PRINTER'S NO.   2247

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 1828
                                               Session of
                                                 2025

     INTRODUCED BY VENKAT, KHAN, KOSIEROWSKI, McNEILL, PROBST,
        T. DAVIS, HILL-EVANS, PIELLI, SCHLOSSBERG, HOWARD, RIVERA,
        INGLIS, SANCHEZ, SAPPEY, HOHENSTEIN, D. WILLIAMS, WAXMAN,
        SIEGEL, MAYES, BELLMON, FRANKEL, STEELE, ISAACSON,
        SHUSTERMAN, BOYD, HADDOCK, HANBIDGE AND BOROWSKI,
        AUGUST 28, 2025

     REFERRED TO COMMITTEE ON INSURANCE, AUGUST 28, 2025


                                    AN ACT
 1   Amending Title 40 (Insurance) of the Pennsylvania Consolidated
 2      Statutes, providing for immunization coverage; and imposing
 3      penalties.
 4      The General Assembly of the Commonwealth of Pennsylvania
 5   hereby enacts as follows:
 6      Section 1.    Title 40 of the Pennsylvania Consolidated
 7   Statutes is amended by adding a chapter to read:
 8                                CHAPTER 52
 9                           IMMUNIZATION COVERAGE
10   Sec.
11   5201.   Scope of chapter.
12   5202.   Definitions.
13   5203.   Immunization coverage requirement.
14   5204.   Additions and exceptions.
15   5205.   Construction.
16   5206.   Regulations.
 1   5207.   Enforcement.
 2   § 5201.   Scope of chapter.
 3      This chapter relates to immunization coverage.
 4   § 5202.   Definitions.
 5      The following words and phrases when used in this chapter
 6   shall have the meanings given to them in this section unless the
 7   context clearly indicates otherwise:
 8      "Advisory Committee on Immunization Practices."     The Advisory
 9   Committee on Immunization Practices of the Centers for Disease
10   Control and Prevention.
11      "Commissioner."     The Insurance Commissioner of the
12   Commonwealth.
13      "Cost-sharing."     The share of health care costs covered by a
14   health insurance policy that an enrollee pays out-of-pocket. The
15   term includes deductibles, coinsurance, copayments and similar
16   charges. The term does not include a premium, a balance billed
17   amount from an out-of-network provider or the cost of a
18   noncovered service.
19      "Enrollee."   The term shall mean the same as defined under
20   section 9103 (relating to definitions).
21      "Grandfathered health care plan."     The term shall mean the
22   same as defined under section 9103.
23      "Health care provider."     A person who is licensed, certified
24   or otherwise regulated to provide health care services under the
25   laws of this Commonwealth.
26      "Health insurance policy."     The term shall mean the same as
27   defined under section 9103.
28      "Immunization."     A vaccine or other immunizing agent. The
29   term includes vaccines or other immunizing agents required to be
30   covered by an individual health insurance policy approved to be

20250HB1828PN2247                    - 2 -
 1   offered or issued in this Commonwealth on January 1, 2025.
 2      "Insurer."         The term shall mean the same as defined under
 3   section 9103.
 4      "Out-of-network provider."          A health care provider who does
 5   not contract with an insurer to provide health care services to
 6   an enrollee under a health insurance policy.
 7   § 5203.    Immunization coverage requirement.
 8      An insurer offering, issuing or renewing a health insurance
 9   policy, other than a grandfathered health care plan, shall
10   provide coverage and may not impose any cost-sharing
11   requirements for an immunization to an enrollee.
12   § 5204.    Additions and exceptions.
13      (a)    Authority of department.--The department may add or
14   except an immunization from the coverage requirement if the
15   Department of Health makes a determination consistent with the
16   requirements of this section.
17      (b)    Additions to coverage requirement.--The department may
18   add an immunization to the coverage requirement and establish
19   the manner and frequency of the administration in consultation
20   with the Department of Health, following a determination by the
21   Department of Health in accordance with the following:
22             (1)   One of the following:
23                   (i)    the immunization is recommended by the Advisory
24             Committee on Immunization Practices; or
25                   (ii)    both of the following are met:
26                          (A)   Immunization of certain populations is
27                   supported by medical evidence.
28                          (B)   Immunization of certain populations would
29                   advance the public health by reducing the spread or
30                   severity of infectious diseases in this Commonwealth.

20250HB1828PN2247                          - 3 -
 1            (2)   In making a determination under paragraph (1)(ii),
 2      the Department of Health may consider a report from any of
 3      the following entities as evidence to support a
 4      determination:
 5                  (i)    The American Academy of Pediatrics.
 6                  (ii)    The American College of Obstetricians and
 7            Gynecologists.
 8                  (iii)    The American College of Physicians.
 9                  (iv)    The American Academy of Family Physicians.
10                  (v)    The Infectious Diseases Society of America.
11                  (vi)    The Society for Maternal-Fetal Medicine.
12      (c)   Exceptions from coverage requirement.--
13            (1)   The department may except an immunization from the
14      coverage requirement following a determination by the
15      Department of Health that the immunization is:
16                  (i)    No longer supported by medical evidence for
17            certain populations.
18                  (ii)    No longer effective to reduce the spread or
19            severity of infectious diseases in this Commonwealth and
20            thereby advance the public health.
21            (2)   The Department of Health may consider a report from
22      any of the entities identified under subsection (b)(2) as
23      evidence to support a determination under paragraph (1).
24      (d)   Notice requirement.--After determination of the
25   Department of Health, the department shall provide notice of the
26   determination and addition or exception of an immunization from
27   the coverage requirement by:
28            (1)   Transmitting a notice to the Legislative Reference
29      Bureau for publication in the next available issue of the
30      Pennsylvania Bulletin.

20250HB1828PN2247                       - 4 -
 1             (2)   Posting the notice on the department's publicly
 2      accessible Internet website.
 3             (3)   Electronically sending the notice to the chairperson
 4      and minority chairperson of the Banking and Insurance
 5      Committee of the Senate and the chairperson and minority
 6      chairperson of the Insurance Committee of the House of
 7      Representatives.
 8      (e)    Effective date of addition or exception.--
 9             (1)   An addition under subsection (b) shall apply as
10      follows:
11                   (i)    For health insurance policies for which either
12             rates or forms are required to be filed with the
13             department, an addition shall apply to any policy for
14             which a form or rate is first filed on or after the
15             effective date of this subparagraph.
16                   (ii)   For health insurance policies for which neither
17             rates nor forms are required to be filed with the
18             department, an addition shall apply to any policy issued
19             or renewed on or after 180 days after the effective date
20             of this subparagraph.
21             (2)   An exception under subsection (c) shall apply as of
22      the date of publication of the notice specified in subsection
23      (d).
24   § 5205.    Construction.
25      (a)    In general.--Nothing in this chapter shall be construed
26   to diminish any other law that limits cost-sharing for a health
27   care service or to prohibit an insurer from:
28             (1)   Providing coverage for immunizations in addition to
29      the immunizations subject to coverage under this chapter.
30             (2)   Denying coverage for immunizations not subject to

20250HB1828PN2247                        - 5 -
 1      coverage under this chapter.
 2            (3)   Using reasonable medical management techniques to
 3      determine the frequency, method, treatment or setting for an
 4      immunization, based on relevant clinical evidence, to the
 5      extent not specified in:
 6                  (i)    the relevant Advisory Committee on Immunization
 7            Practices recommendation supporting the immunization as
 8            of January 1, 2025; or
 9                  (ii)   the Department of Health determination adding a
10            new immunization to coverage requirements.
11      (b)   Network considerations.--For an insurer that uses a
12   network of health care providers to provide immunizations under
13   a health insurance policy:
14            (1)   Subject to paragraph (2), nothing in this chapter
15      shall be construed to:
16                  (i)    Require the insurer to provide coverage for an
17            immunization that is delivered by an out-of-network
18            provider.
19                  (ii)   Preclude the insurer from imposing cost-sharing
20            requirements for an immunization that is delivered by an
21            out-of-network provider.
22            (2)   If an insurer does not have an in-network health
23      care provider who can provide an immunization to an enrollee,
24      the insurer shall cover the immunization when performed by an
25      out-of-network provider and may not impose cost-sharing.
26      (c)   Protections.--Nothing in this chapter shall require a
27   health insurance policy to cover an immunization if the enrollee
28   is exempt by the exercise of the enrollee's constitutional
29   protections of religious freedom under the act of December 9,
30   2002 (P.L.1701, No.214), known as the Religious Freedom

20250HB1828PN2247                       - 6 -
 1   Protection Act, or 42 U.S.C. Ch. 21B (relating to religious
 2   freedom restoration).
 3   § 5206.    Regulations.
 4      The department may promulgate regulations as necessary and
 5   appropriate to carry out the provisions of this chapter.
 6   § 5207.    Enforcement.
 7      (a)    Penalties.--After satisfactory evidence of the violation
 8   of this chapter by an insurer, one or more of the following
 9   penalties may be imposed at the commissioner's discretion:
10             (1)   Suspension or revocation of the offending insurer's
11      license.
12             (2)   Refusal, for a period not to exceed one year, to
13      issue a new license to the offending insurer.
14             (3)   A fine of not more than $5,000 for each violation of
15      this chapter.
16             (4)   A fine of not more than $10,000 for each willful
17      violation of this chapter.
18      (b)    Limitation.--Fines imposed against an insurer under this
19   section may not exceed $500,000 in the aggregate during a single
20   calendar year.
21      (c)    Additional remedies.--The enforcement remedies imposed
22   under this section are in addition to any other remedies or
23   penalties that may be imposed under any other applicable law of
24   this Commonwealth, including:
25             (1)   The act of July 22, 1974 (P.L.589, No.205), known as
26      the Unfair Insurance Practices Act. A violation of this
27      chapter shall be deemed to be an unfair method of competition
28      and an unfair or deceptive act or practice under the Unfair
29      Insurance Practices Act.
30             (2)   The act of December 18, 1996 (P.L.1066, No.159),

20250HB1828PN2247                     - 7 -
 1      known as the Accident and Health Filing Reform Act.
 2            (3)   The act of June 25, 1997 (P.L.295, No.29), known as
 3      the Pennsylvania Health Care Insurance Portability Act.
 4      (d)   Administrative procedure.--The administrative provisions
 5   of this chapter shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
 6   (relating to practice and procedure of Commonwealth agencies). A
 7   party against whom penalties are assessed in an administrative
 8   action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
 9   Ch. 7 Subch. A (relating to judicial review of Commonwealth
10   agency action).
11      Section 2.     All acts and parts of acts are repealed insofar
12   as they are inconsistent with this act.
13      Section 3.     This act shall take effect immediately.




20250HB1828PN2247                    - 8 -