An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for continuity of care.

PRINTER'S NO. 869
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 839
Session of
2025
INTRODUCED BY WEBSTER, SANCHEZ, HILL-EVANS, MADDEN, PIELLI,
MAYES AND CERRATO, MARCH 10, 2025
REFERRED TO COMMITTEE ON INSURANCE, MARCH 10, 2025
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in quality health care
accountability and protection, further providing for
continuity of care.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2117(a), (c) and (d) of the act of May
17, 1921 (P.L.682, No.284), known as The Insurance Company Law
of 1921, are amended and the section is amended by adding a
subsection to read:
Section 2117. Continuity of Care.--(a) Except as provided
under subsection (b), if an insurer or MA or CHIP managed care
plan initiates termination of its contract with a participating
health care provider, or if a participating health care provider
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initiates termination of its contract, with an insurer or MA or
CHIP managed care plan, or if the contract expires or is
nonrenewed by either party, a covered person or enrollee may
continue an ongoing course of treatment with that health care
provider at the covered person's or enrollee's option for a
transitional period of up to [sixty (60)] one hundred twenty
(120) days from the date the covered person or enrollee was
notified by the insurer or MA or CHIP managed care plan of the
termination or pending termination, expiration or nonrenewal.
The insurer or MA or CHIP managed care plan, in consultation
with the covered person or enrollee and the health care
provider, may extend the transitional period if determined to be
clinically appropriate. In the case of a covered person or
enrollee in the second or third trimester of pregnancy at the
time of notice of the termination or pending termination, the
transitional period shall extend through postpartum care related
to the delivery. Any health care service provided under this
section shall be covered by the insurer or MA or CHIP managed
care plan under the same terms and conditions as applicable for
participating health care providers.
* * *
(c) If an insurer or MA or CHIP managed care plan terminates
the contract of a participating primary care provider, or if a
participating health care provider terminates its contract with
an insurer or MA or CHIP managed care plan, or if the contract
expires or is nonrenewed by either party, the insurer or MA or
CHIP managed care plan shall notify every covered person or
enrollee served by that provider of [insurer's or MA or CHIP
managed care plan's termination of its contract] the change in
the provider's network status and shall request that the covered
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person or enrollee select another primary care provider.
(d) A new covered person or enrollee may continue an ongoing
course of treatment with a nonparticipating health care provider
for a transitional period of up to [sixty (60)] one hundred
twenty (120) days from the effective date of enrollment in a
health insurance policy or MA or CHIP managed care plan. The
insurer or MA or CHIP managed care plan, in consultation with
the covered person or enrollee and the health care provider, may
extend this transitional period if determined to be clinically
appropriate. In the case of a new covered person or enrollee in
the second or third trimester of pregnancy on the effective date
of enrollment, the transitional period shall extend through
postpartum care related to the delivery. Any health care service
provided under this section shall be covered by the health
insurance policy or MA or CHIP managed care plan under the same
terms and conditions as applicable for participating health care
providers.
* * *
(g) Where an insurer or MA or CHIP managed care plan has
reimbursed a nonparticipating health care provider for services
provided during the transitional period provided for under
subsection (a) or (d) at the same rate the insurer or MA or CHIP
managed care plan has established for a participating health
care provider, the nonparticipating health care provider may not
bill the covered person or enrollee directly or indirectly or
otherwise attempt to collect from the covered person or enrollee
for the service provided, except for a billing to recover cost
sharing at the rate established for services provided by
participating health care providers, as specified in the health
insurance policy or MA or CHIP managed care plan.
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Section 2. The following shall apply:
(1) For a health insurance policy for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
180 days 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 Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this paragraph.
Section 3. This act shall take effect in 60 days.
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