An Act imposing a moratorium on enactment of new or expanded health insurance policy mandated benefits; and requiring the Legislative Budget and Finance Committee to study the issue of health insurance mandates and report to the General Assembly.

PRINTER'S NO. 1333
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1184
Session of
2025
INTRODUCED BY KEPHART, KAUFFMAN, COOK, ARMANINI, GROVE, KUZMA
AND ZIMMERMAN, APRIL 9, 2025
REFERRED TO COMMITTEE ON INSURANCE, APRIL 9, 2025
AN ACT
Imposing a moratorium on enactment of new or expanded health
insurance policy mandated benefits; and requiring the
Legislative Budget and Finance Committee to study the issue
of health insurance mandates and report to the General
Assembly.
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 State-
mandated Benefit Moratorium 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:
"Committee." The Legislative Budget and Finance Committee.
"Health care provider." A health care facility, medical
equipment supplier or person that is licensed, certified or
otherwise regulated to provide health care services under the
laws of this Commonwealth or another state.
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"Health insurance policy." As follows:
(1) A policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage.
(2) The term includes:
(i) A dental only policy.
(ii) A vision only policy.
(3) The term does not include:
(i) An accident only policy.
(ii) A credit only policy.
(iii) A long-term care or disability income policy.
(iv) A specified disease policy.
(v) A Medicare supplement policy.
(vi) A TRICARE policy, including a Civilian Health
and Medical Program of the Uniformed Services (CHAMPUS)
Supplement Policy.
(vii) A fixed indemnity policy.
(viii) A hospital indemnity policy.
(ix) A workers' compensation policy.
(x) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
(xi) A homeowner's insurance policy.
(xii) Any other similar policies providing for
limited benefits.
"Insurer." An entity that offers, issues or renews an
individual or group health insurance policy that provides
medical or health care coverage by a health care 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
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The Insurance Company Law of 1921, including section 630 and
Article XXIV of The Insurance Company Law of 1921.
(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).
"State-mandated health benefit." As follows:
(1) A benefit that requires a health insurance policy to
do any of the following:
(i) Provide coverage or increase the amount of
coverage for the treatment of a particular disease,
condition or other health care need that exceeds Federal
requirements.
(ii) Provide coverage or increase the amount of
coverage of equipment, supplies or drugs used in
connection with a health care treatment or service that
exceed Federal requirements.
(iii) Provide coverage for care delivered by a
specific type of provider.
(iv) Require a particular benefit design or impose
limitations or restrictions on deductibles, coinsurance,
copayments or any annual or lifetime maximum benefit
amounts.
(v) Impose limits or conditions on a contract
between an insurer and a health care provider.
(2) The term does not include coverage that is mandated
by Federal law or amends the scope of practice of a licensed
health care professional.
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Section 3. Mandated health benefit moratorium.
Until submission to the General Assembly of the report
required under section 5, a moratorium is established during
which the General Assembly may not consider or act on any new or
expanded coverage under a health insurance policy.
Section 4. Construction.
Nothing in this act shall be construed to:
(1) Prohibit an employer or insurer from electing to
provide new or expanded coverage under a health insurance
policy.
(2) Prohibit changes in coverage requirements to comply
with Federal law.
Section 5. Report of existing mandated benefits.
(a) Authorization.--The committee shall evaluate State-
mandated health benefits and the cost to employers and
individuals and shall issue a report to the General Assembly in
accordance with this section.
(b) Contents.--The report under this section must contain
the following:
(1) A list of each existing State-mandated health
benefit placed upon insurers in this Commonwealth.
(2) The fiscal impact of each existing State-mandated
health benefit on the premiums for health insurance policy
coverage in this Commonwealth.
(3) Whether the existing State-mandated health benefits
will result in the Commonwealth being required to make
payments to defray the cost under 42 U.S.C. § 18031(d)(3)
(relating to affordable choices for health benefit plans) and
45 CFR 155.170 (relating to additional required benefits), as
amended.
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(4) The social, financial and medical efficacy of each
State-mandated health benefit.
(c) Issuance.--Not later than December 31, 2026, the
committee shall submit the report required under this section,
which contains its findings and any recommendations, to:
(1) The chairperson and minority chairperson of the
Appropriations Committee of the Senate.
(2) The chairperson and minority chairperson of the
Appropriations Committee of the House of Representatives.
(3) The chairperson and minority chairperson of the
Banking and Insurance Committee of the Senate.
(4) The chairperson and minority chairperson of the
Insurance Committee of the House of Representatives.
(d) Notice.--Upon the submittal of the report under this
section, the committee shall transmit notice of the submittal of
the report to the Legislative Reference Bureau for publication
in the next available issue of the Pennsylvania Bulletin.
Section 6. Effective date.
This act shall take effect immediately.
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