An Act providing for access to contraceptives; imposing duties on the Insurance Department and the Department of Human Services; providing for severability; and imposing penalties.

PRINTER'S NO. 1449
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1140
Session of
2025
INTRODUCED BY KRUEGER, VENKAT, KINKEAD, WAXMAN, GIRAL, BOROWSKI,
HILL-EVANS, PROBST, MALAGARI, GUENST, SMITH-WADE-EL, RABB,
PIELLI, MADDEN, FIEDLER, CURRY, HOHENSTEIN, SANCHEZ, OTTEN,
BOYD, KENYATTA, D. WILLIAMS, O'MARA, RIVERA, DAVIDSON,
CERRATO, STEELE AND SCHLOSSBERG, APRIL 22, 2025
REFERRED TO COMMITTEE ON INSURANCE, APRIL 22, 2025
AN ACT
Providing for access to contraceptives; imposing duties on the
Insurance Department and the Department of Human Services;
providing for severability; and imposing penalties.
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 Contraceptive
Access for All 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:
"Agreement with the Department of Human Services." An
agreement between an MA or CHIP managed care plan and the
Department of Human Services to manage the purchase and
provision of services.
"Cost sharing." As follows:
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(1) The share of the health care costs covered by an MA
or CHIP managed care plan or a health insurance policy that
an enrollee or covered person pays out of pocket.
(2) The term includes a deductible, coinsurance,
copayment or similar charge.
(3) The term does not include a premium, a balance
billed amount from an out-of-network provider or the cost of
a noncovered service.
"Covered person." A policyholder, subscriber, covered person
or other individual who is entitled to receive health care
services under a health insurance policy.
"Department." The Insurance Department of the Commonwealth.
"Enrollee." An individual who is entitled to receive health
care services under an agreement with the Department of Human
Services.
"FDA." The United States Food and Drug Administration.
"Health care provider." An individual who is authorized to
practice some component of the healing arts by a license,
permit, certificate or registration issued by a Commonwealth
licensing agency or board.
"Health insurance policy." As follows:
(1) A policy, subscriber contract, certificate or plan
issued by a health insurer that provides medical or health
care coverage.
(2) The term does not include any of the following:
(i) An accident only policy.
(ii) A credit only policy.
(iii) A long-term care policy.
(iv) A disability income policy.
(v) A specified disease policy.
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(vi) A Medicare supplement policy.
(vii) A fixed indemnity policy.
(viii) A dental only policy.
(ix) A vision only policy.
(x) A workers' compensation policy.
(xi) An automobile medical payment policy.
(xii) A policy under which benefits are provided by
the Federal Government to active or former military
personnel and their dependents.
(xiii) A hospital indemnity policy.
(xiv) Any other similar policy providing for limited
benefits.
"Health insurer." An entity licensed by the department that
offers, issues or renews an individual or group health insurance
policy that is offered or 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) or 63 (relating to professional health services
plan corporations).
"Medical Assistance or CHIP managed care plan" or "MA or CHIP
managed care plan." A health care plan that uses a gatekeeper
to manage the utilization of health care services by medical
assistance or children's health insurance program enrollees and
integrates the financing and delivery of health care services.
"Out-of-network provider." A health care provider who does
not contract with an MA or CHIP managed care plan or a health
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insurer to provide health care services to an enrollee or
covered person.
"Prior authorization." As defined in section 2102 of The
Insurance Company Law of 1921.
"Step therapy." As defined in section 2102 of The Insurance
Company Law of 1921.
Section 3. Minimum coverage requirements.
(a) Mandatory coverage.--
(1) Except as provided in section 5 and subject to
subsection (e), an MA or CHIP managed care plan or health
insurance policy offered, issued or renewed in this
Commonwealth shall provide coverage for all of the following:
(i) Any of the following for which an enrollee or
covered person obtained a prescription:
(A) An FDA-approved contraceptive drug.
(B) An FDA-approved, cleared or granted
contraceptive device or other product.
(ii) All FDA-approved over-the-counter emergency
contraceptive drugs, including levonorgestrel and
ulipristal acetate, for which an enrollee or covered
person obtained a prescription or which is the subject of
a standing order issued under section 4. Coverage
provided under this subparagraph shall not be subject to
prior authorization or step therapy.
(iii) All FDA-approved over-the-counter oral
contraceptive drugs, for which an enrollee or covered
person obtained a prescription or which is the subject of
a standing order issued under section 4. Coverage
provided under this subparagraph shall not be subject to
prior authorization or step therapy.
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(iv) FDA-approved prescription oral contraceptives
intended to last for not more than a three-month period
for the first time that the prescription oral
contraceptive drug is dispensed to the enrollee or
covered person.
(v) (A) Subject to clause (B), FDA-approved
prescription oral contraceptive drugs intended to
last for not more than a 12-month period for any
refill or subsequent dispensing of the prescription
oral contraceptive drug initially prescribed under
subparagraph (i) or (iv). Prescription oral
contraceptive drugs provided under this subparagraph
may be dispensed all at once or over the course of
the 12-month period, regardless of whether the
enrollee or covered person was enrolled in an MA or
CHIP managed care plan or health insurance policy at
the time the prescription oral contraceptive drug was
first dispensed.
(B) An enrollee or covered person may not fill
more than one 12-month prescription oral
contraceptive drug in a single calendar year.
(vi) Voluntary adult male and voluntary adult female
sterilization surgery.
(vii) Items and services integral to the furnishing
of contraceptive drugs, devices and products or voluntary
sterilization surgery, including patient screening,
education and counseling and items and services related
to the evaluation, insertion or removal of a
contraceptive device or continuance or discontinuance of
a contraceptive drug, device or other product.
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(2) Nothing in this subsection shall be construed to:
(i) Require coverage of male condoms.
(ii) Exclude, limit or prohibit coverage for
contraceptive drugs, devices and products used for other
than contraceptive purposes.
(b) Cost sharing prohibited.--Except as provided in
subsection (e)(1)(i)(B), coverage under subsection (a) shall be
provided without imposing any form of cost sharing.
(c) Conditions for coverage.--Except for over-the-counter
emergency contraceptive drugs described in subsection (a)(1)(ii)
and over-the-counter oral contraceptive drugs described in
subsection (a)(1)(iii), an MA or CHIP managed care plan or
health insurance policy may require that items and services
described in subsection (a) are medically necessary or
appropriate as a condition of coverage.
(d) Compliance with law.--An MA or CHIP managed care plan or
health insurer that imposes prior authorization or step therapy
on the items or services described in subsection (c) shall
comply with all applicable Federal and State laws and guidance
concerning prior authorization and step therapy, including:
(1) Section 2155 of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921.
(2) Section 2156 of The Insurance Company Law of 1921.
(3) Subdivision (i) of Article XXI of The Insurance
Company Law of 1921.
(4) Subdivision (i.1) of Article XXI of The Insurance
Company Law of 1921.
(e) Out-of-network providers.--
(1) (i) Subject to subparagraph (ii), nothing in
subsection (a) shall:
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(A) Require a health insurer that has a network
of providers to provide benefits for contraceptive
care covered under subsection (a) that are delivered
by an out-of-network provider.
(B) Preclude a health insurer that has a network
of providers from imposing cost-sharing requirements
for contraceptive care covered under subsection (a)
that are delivered by an out-of-network provider.
(ii) If a health insurer does not have in its
network a provider that can provide contraceptive care
covered under subsection (a), the health insurer shall
cover the contraceptive care when performed by an out-of-
network provider and may not impose cost sharing with
respect to the contraceptive care.
(2) Nothing in this section shall be construed as
limiting an enrollee's ability to receive contraceptive care
from a health care provider in accordance with 42 CFR 431.51
(relating to free choice of providers).
Section 4. Standing order.
(a) Permissible acts.--Notwithstanding any other provision
of law, a health care provider otherwise authorized to prescribe
FDA-approved over-the-counter emergency contraceptive drugs or
FDA-approved over-the-counter oral contraceptive drugs may
dispense, prescribe or distribute the drugs directly or by a
standing order to a person within this Commonwealth.
(b) Issuance of standing order.--The Secretary of Health or
the Physician General of the Commonwealth shall issue a
Statewide standing order in accordance with subsection (a) for
FDA-approved over-the-counter emergency contraceptive drugs and
FDA-approved over-the-counter oral contraceptive drugs.
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(c) Liability.--
(1) Subject to paragraph (2), a health care provider
who, acting in good faith, prescribes or dispenses a drug
pursuant to a standing order under this section shall not be
subject to any criminal or civil liability or any
professional disciplinary action for:
(i) prescribing or dispensing the drug; or
(ii) any outcomes resulting from the eventual
administration of the FDA-approved over-the-counter
emergency contraceptive drug or FDA-approved over-the-
counter oral contraceptive drug.
(2) The immunity under paragraph (1) shall not apply to
a health care provider who acts with intent to harm or with
reckless indifference to a substantial risk of harm.
Section 5. Religious or moral exemption.
(a) General rule.--Notwithstanding the act of December 9,
2002 (P.L.1701, No.214), known as the Religious Freedom
Protection Act, and except as provided in subsection (b), a
health insurance policy issued to an entity or individual that
objects to coverage or payments for contraceptive services under
45 CFR 147.132 (relating to religious exemptions in connection
with coverage of certain preventive health services) or 147.133
(relating to moral exemptions in connection with coverage of
certain preventive health services) is exempt from section 3.
(b) Exception.--An exemption under subsection (a) shall not
apply to contraceptive drugs, devices or products used for
purposes other than contraceptive purposes.
(c) Notice.--An objecting entity exempt from section 3 shall
provide written notice to employees and prospective employees
that health insurance coverage maintained by the entity limits
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or does not provide coverage of contraceptive care described in
section 3(a). The notice shall indicate whether any
contraceptive care is covered and, if so, under what conditions.
Section 6. Confidentiality.
(a) Alternative means of communication.--An MA or CHIP
managed care plan or health insurer must permit and accommodate
a reasonable request by an enrollee or covered person to receive
communications from the MA or CHIP managed care plan or health
insurer regarding the receipt of contraceptive care covered
under section 3 by alternative means or at alternative
locations. A request is reasonable if the enrollee or covered
person states clearly that the disclosure of all or part of that
information could endanger the enrollee or covered person.
(b) Request in writing.--An MA or CHIP managed care plan or
health insurer may require the enrollee or covered person to
make a request for confidential communication described in
subsection (a) in writing.
(c) Condition.--An MA or CHIP managed care plan or health
insurer may condition the provision of a reasonable
accommodation on specification of an alternative address or
other method of contact.
(d) Required statement.--An MA or CHIP managed care plan or
health insurer may require that a request for alternative
communication under subsection (a) contain a statement that
disclosure of all or part of the information to which the
request pertains could endanger the enrollee or covered person.
(e) Denials and requests for additional information.--If an
MA or CHIP managed care plan or health insurer denies or
requests additional information from the covered person or
enrollee regarding a request for confidential communications,
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the MA or CHIP managed care plan or health insurer shall
transmit the denial or request to the covered person or enrollee
in accordance with the alternative means or alternative
locations selected by the covered person or enrollee in the
request for confidential communications.
Section 7. Reporting requirements.
(a) Information required.--Medical assistance or CHIP
managed care plans and health insurers shall annually report to
the department the number, type and disposition of each
complaint, grievance, internal appeal and adverse benefit
determination filed with the MA or CHIP managed care plan or
health insurer regarding contraceptive care.
(b) Inclusion in annual report.--The information received
under subsection (a) shall be included in the annual reports
submitted by the department under section 2181(f) of the act of
May 17, 1921 (P.L.682, No.284), known as The Insurance Company
Law of 1921.
(c) Definitions.--As used in this section, the terms
"adverse benefit determination," "complaint" and "grievance"
shall have the meanings given to them in section 2102 of The
Insurance Company Law of 1921.
Section 8. Enforcement.
(a) Penalties.--Upon satisfactory evidence of the violation
of this act by an MA or CHIP managed care plan, health insurer
or other person, subject to subsection (b), one or more of the
following penalties may be imposed at the discretion of the
Insurance Commissioner or the Department of Human Services, as
appropriate:
(1) Suspension or revocation of the license of the
offending health insurer.
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(2) Refusal, for a period not to exceed one year, to
issue a new license to the offending health insurer.
(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 MA or CHIP managed care
plan or health 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. A violation of this act
shall be deemed to be an unfair method of competition and
unfair or deceptive act or practice under that act.
(2) The act of December 18, 1996 (P.L.1066, No.159),
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) Administration.--
(1) The provisions of this section shall be subject to 2
Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of
Commonwealth agencies).
(2) A party against whom penalties are assessed in an
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administrative action under this section 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 9. Regulations.
(a) Department of Human Services.--The Department of Human
Services may promulgate necessary and appropriate regulations
with respect to MA or CHIP managed care plans to implement,
administer and enforce this act.
(b) Insurance Department.--The department may promulgate
necessary and appropriate regulations with respect to health
insurers and health insurance policies to implement, administer
and enforce this act.
Section 10. 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 Federal Government
or 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 paragraph.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the department, this act shall apply to any
policy issued or renewed on or after 180 days after the
effective date of this paragraph.
Section 11. Severability.
The provisions of this act are severable. If a provision of
this act or the provision's application to a person or
circumstance is held invalid, the invalidity shall not affect
other provisions or applications of this act which can be given
effect without the invalid provision or application.
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Section 12. Effective date.
This act shall take effect in 60 days.
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