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PRIOR PRINTER'S NO. 2247 PRINTER'S NO. 2415
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, BOROWSKI, MUNROE,
SALISBURY, OTTEN, MERSKI, KINKEAD, GREEN AND SCOTT,
AUGUST 28, 2025
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, OCTOBER 7, 2025
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for immunization coverage; and imposing
penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 52
IMMUNIZATION COVERAGE
Sec.
5201. Scope of chapter.
5202. Definitions.
5203. Immunization coverage requirement.
5204. Additions and exceptions.
5205. Construction.
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5206. Regulations.
5207. Enforcement.
§ 5201. Scope of chapter.
This chapter relates to immunization coverage.
§ 5202. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Advisory Committee on Immunization Practices." The Advisory
Committee on Immunization Practices of the Centers for Disease
Control and Prevention.
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Cost-sharing." The share of health care costs covered by a
health insurance policy that an enrollee pays out-of-pocket. The
term includes deductibles, coinsurance, copayments and similar
charges. The term does not include a premium, a balance billed
amount from an out-of-network provider or the cost of a
noncovered service.
"Enrollee." The term shall mean the same as defined under
section 9103 (relating to definitions).
"Grandfathered health care plan." The term shall mean the
same as defined under section 9103.
"Health care provider." A person who is licensed, certified
or otherwise regulated to provide health care services under the
laws of this Commonwealth.
"Health insurance policy." The term shall mean the same as
defined under section 9103.
"Immunization." A vaccine or other immunizing agent. The
term includes vaccines or other immunizing agents required to be
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covered by an individual health insurance policy approved to be
offered or issued in this Commonwealth on January 1, 2025.
"Insurer." The term shall mean the same as defined under
section 9103.
"Out-of-network provider." A health care provider who does
not contract with an insurer to provide health care services to
an enrollee under a health insurance policy.
§ 5203. Immunization coverage requirement.
An insurer offering, issuing or renewing a health insurance
policy , other than a grandfathered health care plan, shall
provide coverage and may not impose any cost-sharing
requirements for an immunization to an enrollee. THE
REQUIREMENTS OF THIS SECTION SHALL NOT APPLY TO A GRANDFATHERED
HEALTH CARE PLAN.
§ 5204. Additions and exceptions.
(a) Authority of department.--The department may , IN
CONSULTATION WITH THE DEPARTMENT OF HEALTH, add or except an
immunization from the coverage requirement if the Department of
Health makes a determination consistent with the requirements of
this section.
(b) Additions to coverage requirement.--The department may
add an immunization to the coverage requirement and establish
the manner and frequency of the administration in consultation
with the Department of Health, following BASED ON a
determination by the Department of Health in accordance with the
following:
(1) One of the following:
(i) the immunization is recommended by the Advisory
Committee on Immunization Practices; or
(ii) both of the following are met:
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(A) Immunization of certain populations is
supported by medical evidence.
(B) Immunization of certain populations would
advance the public health by reducing the spread or
severity of infectious diseases in this Commonwealth.
(2) In making a determination under paragraph (1)(ii),
the Department of Health may consider a report from any of
the following entities as evidence to support a
determination:
(i) The American Academy of Pediatrics.
(ii) The American College of Obstetricians and
Gynecologists.
(iii) The American College of Physicians.
(iv) The American Academy of Family Physicians.
(v) The Infectious Diseases Society of America.
(vi) The Society for Maternal-Fetal Medicine.
(c) Exceptions from coverage requirement.--
(1) The department may except an immunization from the
coverage requirement following a determination by the
Department of Health that the immunization is NO LONGER :
(i) No longer supported by medical evidence for
certain populations . ; AND
(ii) No longer effective to reduce the spread or
severity of infectious diseases in this Commonwealth and
thereby advance the public health.
(2) The Department of Health may consider a report from
any of the entities identified under subsection (b)(2) (B) as
evidence to support a determination under paragraph (1).
(d) Notice requirement.--After A determination of the
Department of Health, the department shall provide notice of the
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determination and addition or exception of an immunization from
the coverage requirement by:
(1) Transmitting a notice to the Legislative Reference
Bureau for publication in the next available issue of the
Pennsylvania Bulletin.
(2) Posting the notice on the department's publicly
accessible Internet website.
(3) Electronically sending the notice to the chairperson
and minority chairperson of the Banking and Insurance
Committee of the Senate and the chairperson and minority
chairperson of the Insurance Committee of the House of
Representatives.
(e) Effective date of addition or exception.--
(1) An addition under subsection (b) shall apply as
follows:
(i) For health insurance policies for which either
rates or forms are required to be filed with the
department, an addition shall apply to any policy for
which a form or rate is first filed on or after the
effective date of this subparagraph.
(ii) For health insurance policies for which neither
rates nor forms are required to be filed with the
department, an addition shall apply to any policy issued
or renewed on or after 180 days after the effective date
of this subparagraph.
(2) An exception under subsection (c) shall apply as of
the date of publication of the notice specified in subsection
(d).
§ 5205. Construction.
(a) In general.--Nothing in this chapter shall be construed
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to diminish any other law that limits cost-sharing for a health
care service or to prohibit an insurer from:
(1) Providing coverage for immunizations in addition to
the immunizations subject to coverage under this chapter.
(2) Denying coverage for immunizations not subject to
coverage under this chapter.
(3) Using reasonable medical management techniques to
determine the frequency, method, treatment or setting for an
immunization, based on relevant clinical evidence, to the
extent not specified in:
(i) the relevant Advisory Committee on Immunization
Practices recommendation supporting the immunization as
of January 1, 2025; or
(ii) the Department of Health determination adding a
new immunization to coverage requirements.
(b) Network considerations.--For an insurer that uses a
network of health care providers to provide immunizations under
a health insurance policy:
(1) Subject to paragraph (2), nothing in this chapter
shall be construed to:
(i) Require the insurer to provide coverage for an
immunization that is delivered by an out-of-network
provider.
(ii) Preclude the insurer from imposing cost-sharing
requirements for an immunization that is delivered by an
out-of-network provider.
(2) If an insurer does not have an in-network health
care provider who can provide an immunization to an enrollee,
the insurer shall cover the immunization when performed by an
out-of-network provider and may not impose cost-sharing.
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(c) Protections.--Nothing in this chapter shall require a
health insurance policy to cover an immunization if the enrollee
is exempt by the exercise of the enrollee's constitutional
protections of religious freedom under the act of December 9,
2002 (P.L.1701, No.214), known as the Religious Freedom
Protection Act, or 42 U.S.C. Ch. 21B (relating to religious
freedom restoration).
§ 5206. Regulations.
The department may promulgate regulations as necessary and
appropriate to carry out the provisions of this chapter.
§ 5207. Enforcement.
(a) Penalties.--After satisfactory evidence of the violation
of this chapter by an insurer, one or more of the following
penalties may be imposed at the commissioner's discretion:
(1) Suspension or revocation of the offending insurer's
license.
(2) Refusal, for a period not to exceed one year, to
issue a new license to the offending insurer.
(3) A fine of not more than $5,000 for each violation of
this chapter.
(4) A fine of not more than $10,000 for each willful
violation of this chapter.
(b) Limitation.--Fines imposed against an insurer under this
section may not exceed $500,000 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
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the Unfair Insurance Practices Act. A violation of this
chapter shall be deemed to be an unfair method of competition
and an unfair or deceptive act or practice under the Unfair
Insurance Practices 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) Administrative procedure.--The administrative provisions
of this chapter shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies). A
party against whom penalties are assessed in an administrative
action 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 2. All acts and parts of acts are repealed insofar
as they are inconsistent with this act.
Section 3. This act shall take effect immediately.
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