SB 52 — An Act providing for health care insurance coverage protections, for duties of the Insurance Department and the Insurance Commissioner, for regulations, for enforcement and for penalties.

PRINTER'S NO.    96

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                        SENATE BILL
                        No. 52
                                               Session of
                                                 2025

     INTRODUCED BY HUGHES, KIM, BOSCOLA, CAPPELLETTI, COLLETT,
        COMITTA, COSTA, FLYNN, FONTANA, HAYWOOD, KANE, KEARNEY,
        MILLER, MUTH, PISCIOTTANO, SANTARSIERO, SAVAL, SCHWANK,
        STREET, TARTAGLIONE, A. WILLIAMS AND L. WILLIAMS,
        JANUARY 22, 2025

     REFERRED TO BANKING AND INSURANCE, JANUARY 22, 2025


                                    AN ACT
 1   Providing for health care insurance coverage protections, for
 2      duties of the Insurance Department and the Insurance
 3      Commissioner, for regulations, for enforcement and for
 4      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 Protection Against Limitations 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      "Department."    The Insurance Department of the Commonwealth.
17      "Enrollee."    A policyholder, subscriber, covered person or
 1   other individual who is entitled to receive health care services
 2   under a health insurance policy.
 3      "Group health insurance policy."        A policy, subscriber
 4   contract, certificate or plan issued by an insurer that provides
 5   medical or health care coverage on an annual basis to
 6   individuals who obtain health insurance coverage through a
 7   group.
 8      "Health insurance policy."     A policy, subscriber contract,
 9   certificate or plan issued by an insurer that provides medical
10   or health care coverage. The term does not include any of the
11   following:
12            (1)    An accident only policy.
13            (2)    A credit only policy.
14            (3)    A long-term care or disability income policy.
15            (4)    A specified disease policy.
16            (5)    A Medicare supplement policy.
17            (6)    A fixed indemnity policy.
18            (7)    A dental only policy.
19            (8)    A vision only policy.
20            (9)    A workers' compensation policy.
21            (10)    An automobile medical payment policy.
22            (11)    A policy under which benefits are provided by the
23      Federal Government to active or former military personnel and
24      their dependents.
25            (12)    Any other similar policies providing for limited
26      benefits.
27      "In-network provider."     A provider who contracts with an
28   insurer to provide health care services to an enrollee under a
29   health insurance policy.
30      "Individual health insurance policy."        A policy, subscriber

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 1   contract, certificate or plan issued by an insurer that provides
 2   medical or health care coverage on an annual basis to an
 3   individual other than in connection with a group.
 4      "Insurer."     An entity that offers, issues or renews an
 5   individual or group health insurance policy that provides
 6   medical or health care coverage by a health care facility or
 7   licensed health care provider and that is governed under any of
 8   the following:
 9            (1)   The act of May 17, 1921 (P.L.682, No.284), known as
10      The Insurance Company Law of 1921, including section 630 and
11      Article XXIV thereof.
12            (2)   The act of December 29, 1972 (P.L.1701, No.364),
13      known as the Health Maintenance Organization Act.
14            (3)   40 Pa.C.S. Ch. 61 (relating to hospital plan
15      corporations).
16            (4)   40 Pa.C.S. Ch. 63 (relating to professional health
17      services plan corporations).
18      "Out-of-network provider."     A provider who does not contract
19   with an insurer to provide health care services to an enrollee
20   under a health insurance policy.
21   Section 3.     Limitation on annual and lifetime limits.
22      (a)   Limits.--Except as otherwise provided in this section,
23   an insurer offering, issuing or renewing an individual or group
24   health insurance policy may not establish, on either an annual
25   or lifetime basis, a limit on the dollar value of any core
26   benefit for an enrollee, whether provided by an in-network
27   provider or out-of-network provider.
28      (b)   Core benefit.--For purposes of this section, a core
29   benefit shall include:
30            (1)   A benefit for which no annual or lifetime per

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 1      enrollee limit was permitted to be included in an individual
 2      or small group policy first offered or issued in this
 3      Commonwealth in 2018.
 4            (2)   A benefit hereafter specified by the department by
 5      regulation.
 6      (c)   Benefits not subject to limitation.--The commissioner
 7   may promulgate regulations to exempt a benefit from the
 8   definition of core benefit under subsection (b) for the purposes
 9   of the limitation prohibitions under this section.
10      (d)   No coverage requirement.--This section shall not be
11   construed to require coverage of any specific benefit.
12   Section 4.     Regulations.
13      (a)   Authority to promulgate.--The department may promulgate
14   regulations as may be necessary and appropriate to carry out the
15   provisions of this act.
16      (b)   Temporary regulations.--
17            (1)   In order to facilitate the prompt implementation of
18      this act, the department may issue temporary regulations
19      which shall expire no later than two years following
20      publication of the temporary regulations in the Pennsylvania
21      Bulletin. The temporary regulations shall be exempt from the
22      following:
23                  (i)    Section 612 of the act of April 9, 1929
24            (P.L.177, No.175), known as The Administrative Code of
25            1929.
26                  (ii)    Sections 201, 202, 203, 204 and 205 of the act
27            of July 31, 1968 (P.L.769, No.240), referred to as the
28            Commonwealth Documents Law.
29                  (iii)    Section 204(b) of the act of October 15, 1980
30            (P.L.950, No.164), known as the Commonwealth Attorneys

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 1            Act.
 2                   (iv)   The act of June 25, 1982 (P.L.633, No.181),
 3            known as the Regulatory Review Act.
 4            (2)    The authority of the department to issue temporary
 5      regulations under this subsection shall expire two years from
 6      the effective date of this section. Regulations adopted after
 7      the two-year period shall be promulgated as provided by
 8      statute.
 9   Section 5.      Enforcement.
10      (a)   Penalties.--Upon satisfactory evidence of the violation
11   of any section of this act by an insurer or any other person,
12   one or more of the following penalties may be imposed at the
13   commissioner's discretion:
14            (1)    Suspension or revocation of the license of the
15      offending insurer or other person.
16            (2)    Refusal, for a period not to exceed one year, to
17      issue a new license to the offending insurer or other person.
18            (3)    A fine of not more than $5,000 for each violation of
19      this act.
20            (4)    A fine of not more than $10,000 for each willful
21      violation of this act.
22      (b)   Limitation.--
23            (1)    Fines imposed against an individual insurer under
24      this act may not exceed $500,000 in the aggregate during a
25      single calendar year.
26            (2)    Fines imposed against any other person under this
27      act may not exceed $100,000 in the aggregate during a single
28      calendar year.
29      (c)   Additional remedies.--The enforcement remedies imposed
30   under this section are in addition to any other remedies or

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 1   penalties that may be imposed under any other applicable law of
 2   this Commonwealth, including:
 3            (1)   The act of July 22, 1974 (P.L.589, No.205), known as
 4      the Unfair Insurance Practices Act. Violations of this act
 5      shall be deemed to be an unfair method of competition and an
 6      unfair or deceptive act or practice under the Unfair
 7      Insurance Practices Act.
 8            (2)   The act of December 18, 1996 (P.L.1066, No.159),
 9      known as the Accident and Health Filing Reform Act.
10            (3)   The act of June 25, 1997 (P.L.295, No.29), known as
11      the Pennsylvania Health Care Insurance Portability Act.
12      (d)   Administrative procedure.--The administrative provisions
13   of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
14   (relating to practice and procedure of Commonwealth agencies).
15   A party against whom penalties are assessed in an administrative
16   action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
17   Ch. 7 Subch. A (relating to judicial review of Commonwealth
18   agency action).
19   Section 6.     Repeals.
20      All acts and parts of acts are repealed insofar as they are
21   inconsistent with this act.
22   Section 7.     Applicability.
23      This act shall apply as follows:
24            (1)   For health insurance policies for which either rates
25      or forms are required to be filed with the Insurance
26      Department, this act shall apply to any policy for which a
27      form or rate is first filed on or after the effective date of
28      this section.
29            (2)   For health insurance policies for which neither
30      rates nor forms are required to be filed with the Insurance

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1      Department, this act shall apply to any policy issued or
2      renewed on or after 180 days after the effective date of this
3      section.
4   Section 8.    Effective date.
5      This act shall take effect immediately.




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