SB 610 — 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 enrolled dependents right to confidentiality for health care services received.

PRINTER'S NO.   616

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                        SENATE BILL
                        No. 610
                                               Session of
                                                 2025

     INTRODUCED BY CAPPELLETTI, SCHWANK, HAYWOOD, COSTA AND KANE,
        APRIL 9, 2025

     REFERRED TO BANKING AND INSURANCE, APRIL 9, 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 enrolled dependents right to confidentiality for health
13      care services received.
14      The General Assembly of the Commonwealth of Pennsylvania
15   hereby enacts as follows:
16      Section 1.    The act of May 17, 1921 (P.L.682, No.284), known
17   as The Insurance Company Law of 1921, is amended by adding a
18   section to read:
19      Section 635.11.    Enrolled Dependents Right to Confidentiality
20   for Health Care Services Received.--(a)   A health insurance
21   policy or government program that is offered, issued or renewed
22   in this Commonwealth shall include policies and procedures that
23   comply with Federal and State law to ensure that all
 1   identifiable information regarding receipt of health care
 2   services by a protected enrolled dependent is adequately
 3   protected and remains confidential.
 4      (b)   A health insurer shall develop a standardized
 5   confidential communications request form, in an easily readable
 6   and understandable format as approved by the department, to
 7   permit a protected enrolled dependent to request an alternative
 8   method for receiving confidential communication related to the
 9   receipt of health care services, according to the following:
10      (1)   A health insurer shall permit any protected enrolled
11   dependent to submit a confidential communications request.
12      (2)   A request by a protected enrolled dependent exercising
13   the option for confidential communication shall be submitted in
14   writing using the standardized form.
15      (3)   The availability of the standardized form shall be
16   disseminated in a health insurance policy or government program.
17      (c)   Confidential communications subject to the requirements
18   of this section include the following:
19      (1)   explanation of benefits;
20      (2)   information related to an appointment for health care
21   services;
22      (3)   a claim denial;
23      (4)   a request for additional information related to a claim;
24      (5)   a notice of a contested claim;
25      (6)   the name and address of a provider, a description of
26   services provided and other visit information; and
27      (7)   any written, oral or electronic communication from a
28   carrier that contains protected health information.
29      (d)   Alternative methods of receiving confidential
30   communication shall include:

20250SB0610PN0616                   - 2 -
 1      (1)   sending a paper form to an alternate address as
 2   requested by the protected enrolled dependent;
 3      (2)   sending electronic communication to an alternate
 4   electronic address as requested by the protected enrolled
 5   dependent; or
 6      (3)   withholding confidential communication as requested by
 7   the protected enrolled dependent until an alternative method of
 8   receiving communication is requested subsequently at a later
 9   date by the protected enrolled dependent. A protected enrolled
10   dependent shall be permitted to submit a subsequent request
11   orally in-person or by telephone, or by paper or electronic
12   written communication.
13      (e)   In the event that a protected enrolled dependent has no
14   liability for payment for a procedure or service, a health
15   insurance policy or government program shall permit a protected
16   enrolled dependent to request suppression of all confidential
17   communications, in which case the explanation of benefits, or
18   any confidential communication covered under this section, shall
19   not be issued.
20      (f)   A health insurer or government program shall ensure that
21   requests for confidential communication required under
22   subsection (b) are implemented not later than three business
23   days after receipt of a request. A health insurer shall
24   acknowledge receipt of a protected enrolled dependent's
25   confidential communications request form by providing notice to
26   the protected enrolled dependent through the alternative method
27   of communication as requested by the protected enrolled
28   dependent.
29      (g)   The department, in collaboration with the Department of
30   Health, may develop and implement a plan to educate health care

20250SB0610PN0616                  - 3 -
 1   providers and consumers regarding the rights of protected
 2   enrolled dependents and the responsibilities of health insurers
 3   to promote compliance with this section, according to the
 4   following:
 5      (1)    The plan shall include staff training and other
 6   education for:
 7      (i)    All administrative staff involved in patient
 8   registration and confidentiality education.
 9      (ii)     All billing staff involved in processing insurance
10   claims.
11      (iii)     Education for health care providers employed in a
12   health care facility as defined in section 802.1 of the act of
13   July 19, 1979 (P.L.130, No.48), known as the "Health Care
14   Facilities Act."
15      (iv)     Education for health care providers employed in school
16   health services as provided under Article XIV of the act of
17   March 10, 1949 (P.L.30, No.14), known as the "Public School Code
18   of 1949."
19      (2)    The plan shall include instruction for health care
20   providers to disseminate a protected enrolled dependent's right
21   to exercise the alternative delivery of confidential
22   communications in a manner that clearly displays its
23   availability to patients.
24      (h)    The department may promulgate regulations necessary to
25   implement and enforce this section, which may include
26   requirements for reasonable reporting by a health insurer that
27   issues, delivers, executes or renews a policy covered under this
28   section to the department regarding compliance and the number
29   and type of complaints received regarding noncompliance with
30   this section.

20250SB0610PN0616                    - 4 -
 1      (i)   The department shall submit an annual report to the
 2   chairperson and minority chairperson of the Banking and
 3   Insurance Committee of the Senate and the chairperson and
 4   minority chairperson of the Insurance Committee of the House of
 5   Representatives, which shall be made available on the
 6   department's publicly accessible Internet website, to
 7   disseminate the following information:
 8      (1)   Aggregate data for health insurer reporting requirements
 9   as established under subsection (h).
10      (2)   The effectiveness of the requirements established under
11   this section in enabling protected enrolled dependents to
12   request an alternative method for receiving confidential
13   communications.
14      (3)   Education and outreach conducted by health insurers and
15   providers to inform protected enrolled dependents about the
16   protected enrolled dependent's right to request an alternative
17   method for receiving confidential communication related to the
18   receipt of health care services.
19      (j)   The department shall implement an appeals process for
20   the denial or partial denial by a health insurer of a claim
21   provided to a protected enrolled dependent who has exercised the
22   right to an alternative method for receiving confidential
23   communications covered by this section, according to the
24   following:
25      (1)   A protected enrolled dependent has the right to appeal a
26   denial or partial denial of a claim.
27      (2)   An enrollee, subscriber or certificate holder is
28   prohibited from appealing a denial or partial denial of a claim
29   unless the protected enrolled dependent has provided written
30   authorization to disclose claims information relevant to the

20250SB0610PN0616                  - 5 -
 1   appeal.
 2      (k)    This section shall apply as follows:
 3      (1)    For a health insurance policy or government program for
 4   which either rates or forms are required to be filed with the
 5   Federal Government or the department, this section shall apply
 6   to a policy for which a form or rate is first permitted to be
 7   used on or after 180 days after the effective date of this
 8   subsection.
 9      (2)    For a health insurance policy or government program for
10   which neither rates nor forms are required to be filed with the
11   Federal Government or the department, this section shall apply
12   to a policy issued or renewed on or after 180 days after the
13   effective date of this subsection.
14      (l)    The following words and phrases when used in this
15   section shall have the meanings given to them in this subsection
16   unless the context clearly indicates otherwise:
17      "Department."    The Insurance Department of the Commonwealth.
18      "Government program."     The following:
19      (1)    Subarticle (f) of Article IV of the act of June 13, 1967
20   (P.L.31, No.21), known as the "Human Services Code."
21      (2)    The Commonwealth's children's health insurance program
22   under Article XXIII-A.
23      "Health care practitioner."     An individual who is authorized
24   to practice some component of the healing arts by a license,
25   permit, certificate or registration issued by a Commonwealth
26   licensing agency or board.
27      "Health care provider."     Any of the following:
28      (1)    A health care practitioner as defined in section 103 of
29   the "Health Care Facilities Act."
30      (2)    A federally qualified health center as defined in 42

20250SB0610PN0616                    - 6 -
 1   U.S.C. § 1395x(aa)(4) (relating to definitions).
 2      (3)    A rural health clinic as defined in 42 U.S.C. §
 3   1395x(aa)(2).
 4      (4)    A pharmacist who holds a valid license under the act of
 5   September 27, 1961 (P.L.1700, No.699), known as the "Pharmacy
 6   Act."
 7      (5)    A social worker, clinical social worker, marriage and
 8   family therapist or professional counselor who holds a valid
 9   license under the act of July 9, 1987 (P.L.220, No.39), known as
10   the "Social Workers, Marriage and Family Therapists and
11   Professional Counselors Act."
12      (6)    A registered professional nurse who holds a valid
13   license under the act of May 22, 1951 (P.L.317, No.69), known as
14   "The Professional Nursing Law."
15      "Health insurance policy."     The following:
16      (1)    An individual or group health insurance policy,
17   subscriber contract, certificate or plan that provides medical
18   or health care coverage for services provided by a health care
19   facility or licensed health care provider on an expense-incurred
20   service or prepaid basis and that is offered by or is governed
21   under any of the following:
22      (i)    This act, including section 630.
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. Chs. 61 (relating to hospital plan
26   corporations) and 63 (relating to professional health services
27   plan corporations).
28      (2)    The term does not include the following policies:
29      (i)    Accident only.
30      (ii)    Credit only.

20250SB0610PN0616                    - 7 -
 1      (iii)    Long-term care or disability income.
 2      (iv)    Specified disease.
 3      (v)    Medicare supplement.
 4      (vi)    TRICARE, including Civilian Health and Medical Program
 5   of the Uniformed Services (CHAMPUS) supplement.
 6      (vii)    Fixed indemnity.
 7      (viii)    Dental only.
 8      (ix)    Vision only.
 9      (x)    Workers' compensation.
10      (xi)    Automobile medical payment insurance under 75 Pa.C.S.
11   (relating to vehicles).
12      "Health insurer."      An entity offering a health insurance
13   policy or government program.
14      "Protected enrolled dependent."       The following:
15      (1)    An adult covered as a dependent on a health insurance
16   policy.
17      (2)    A minor authorized to consent to medical, dental and
18   health services under State law that is covered as a dependent
19   on a policyholder's insurance policy.
20      "Protected health information."       As defined in Federal
21   regulation under 45 CFR 160.103 (relating to definitions)
22   promulgated under the administrative simplification provisions
23   of the Health Insurance Portability and Accountability Act of
24   1996 (Public Law 104-191, 110 Stat. 1936).
25      Section 2.    This act shall take effect in 60 days.




20250SB0610PN0616                     - 8 -