Read the full stored bill text
PRINTER'S NO. 3714
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2673
Session of
2026
INTRODUCED BY VENKAT, KHAN, KOSIEROWSKI, WAXMAN, ABNEY,
MALAGARI, KINKEAD, RIVERA, BOROWSKI, STEELE, GUZMAN,
HOHENSTEIN, SANCHEZ, BOYD, D. WILLIAMS AND PASHINSKI,
JUNE 26, 2026
REFERRED TO COMMITTEE ON INSURANCE, JUNE 26, 2026
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for preventive services coverage.
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
PREVENTIVE SERVICES COVERAGE
Sec.
5201. Scope of chapter.
5202. Definitions.
5203. Preventive services coverage requirements.
5204. Additions and exceptions.
5205. Construction.
5206. Regulations.
5207. Enforcement.
§ 5201. Scope of chapter.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
This chapter relates to preventive services 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." As defined in section 9103 (relating to
definitions).
"Grandfathered health care plan." As defined in 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." A policy, subscriber contract,
certificate or plan issued by an insurer that provides medical
or health care coverage. The term does not include any of the
following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
20260HB2673PN3714 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A fixed indemnity policy.
(7) A dental only policy.
(8) A vision only policy.
(9) A workers' compensation policy.
(10) An automobile medical payment policy.
(11) A policy under which benefits are provided by the
Federal Government to active or former military personnel and
their dependents.
(12) A hospital indemnity policy.
(13) Any other similar policy providing for limited
benefits.
"Immunization." A vaccine or other immunizing agent. The
term includes vaccines or other immunizing agents required to be
covered by an individual health insurance policy approved to be
offered or issued in this Commonwealth on January 1, 2025.
"Insurer." As defined in 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.
"Preventive service." A health care service that is on the
preventive services list.
"Preventive services list." A list of health care services
compiled by the department that includes health care services:
(1) Required to be covered by an individual health
insurance policy approved to be offered or issued in this
Commonwealth on January 1, 2025, as a preventive service in
accordance with 42 U.S.C. § 300gg-13 (relating to coverage of
preventive health services), other than any health care
20260HB2673PN3714 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
service exempted by the department under the modification
process under section 5204 (relating to additions and
exceptions).
(2) Added by the department under the modification
process under section 5204.
§ 5203. Preventive services coverage requirements.
An insurer offering, issuing or renewing a health insurance
policy shall provide coverage and may not impose any cost-
sharing requirements for services on the preventive services
list. 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 a
preventive service from the preventive services list if the
Department of Health makes a determination consistent with the
requirements of this section.
(b) Additions to preventive services list.--The department
may add a preventive service to the preventive services list and
establish the manner and frequency of the service's
administration based on a determination by the Department of
Health of at least one of the following:
(1) The service is then-currently:
(i) an evidence-based item or service that has in
effect a rating of "A" or "B" by the United States
Preventive Services Task Force;
(ii) a recommended immunization by the Advisory
Committee on Immunization Practices; or
(iii) a preventive care or screening for women,
infants, children or adolescents provided for in the
20260HB2673PN3714 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
comprehensive guidelines supported by the United States
Health Resources and Services Administration.
(2) Both of the following criteria are met:
(i) Application of the preventive service is
supported by medical evidence.
(ii) Application of the preventive service would
promote the public health within this Commonwealth.
(c) Report to support addition.--In making a determination
under subsection (b)(2), the Department of Health may consider
guidance and recommendations from additional medical and
scientific organizations, including, but not limited to:
(1) The American Academy of Pediatrics.
(2) The American College of Obstetricians and
Gynecologists.
(3) The American College of Physicians.
(4) The American Academy of Family Physicians.
(5) The Infectious Diseases Society of America.
(6) The Society for Maternal-Fetal Medicine.
(7) The American Cancer Society.
(8) The American Heart Association.
(d) Exceptions to preventive services list.--
(1) The department may except a preventive service from
the preventive services list following a determination by the
Department of Health that the application of the preventive
service is no longer:
(i) supported by medical evidence; and
(ii) effective to advance the public health in this
Commonwealth.
(2) The Department of Health may consider a report from
any of the entities identified under subsection (b) or (c) as
20260HB2673PN3714 - 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
evidence to support a determination under paragraph (1).
(e) Notice requirement.--After a determination by the
Department of Health, the department shall provide notice of the
determination and the addition or exception of a preventive
service from the preventive services list in the following
manner:
(1) Transmit notice to the Legislative Reference Bureau
for publication in the next available issue of the
Pennsylvania Bulletin. The notice shall include a public
comment period, which shall be for not less than 15 business
days following the date of publication.
(2) Post the notice on the department's publicly
accessible Internet website.
(3) Electronically send 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.
(f) 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
20260HB2673PN3714 - 6 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
of this subparagraph.
(2) An exception under subsection (d) shall apply as of
the date of publication of the notice specified in subsection
(e).
§ 5205. Construction.
(a) In general.--Nothing in this chapter shall be construed
to diminish any other law that limits cost sharing for a health
care service or to prohibit an insurer from:
(1) Providing coverage for preventive services in
addition to those on the preventive services list.
(2) Denying coverage for preventive services not subject
to this chapter.
(3) Using reasonable medical management techniques to
determine the frequency, method, treatment or setting for a
preventive service, based on relevant clinical evidence, to
the extent not specified in:
(i) the relevant Federal recommendation or guideline
supporting the preventive service as of January 1, 2025;
or
(ii) the Department of Health determination adding a
new preventive service to the preventive services list.
(b) Network considerations.--For an insurer that uses a
network of health care providers to provide preventive services
under a health insurance policy:
(1) Except as provided under paragraph (2), nothing in
this chapter shall be construed to:
(i) require the insurer to provide coverage for a
preventive service that is delivered by an out-of-network
provider; or
(ii) preclude the insurer from imposing cost-sharing
20260HB2673PN3714 - 7 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
requirements for a preventive service that is delivered
by an out-of-network provider.
(2) If the insurer does not have an in-network health
care provider who can provide a preventive service to an
enrollee, the insurer shall cover the preventive service when
performed by an out-of-network provider and may not impose
cost sharing.
(c) Protections.--Nothing in this chapter shall require a
health insurance policy to cover a preventive service 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.--Upon a showing of satisfactory evidence of
an insurer's violation of this chapter, 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.
20260HB2673PN3714 - 8 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(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
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.
20260HB2673PN3714 - 9 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26