An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for menopause treatment coverage.

PRINTER'S NO. 1368
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1122
Session of
2025
INTRODUCED BY COLLETT, STREET, TARTAGLIONE, SANTARSIERO,
HAYWOOD, HUGHES AND KANE, DECEMBER 22, 2025
REFERRED TO BANKING AND INSURANCE, DECEMBER 22, 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 casualty insurance, providing
for menopause treatment coverage.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.11. Menopause Treatment Coverage.--(a) A health
insurance policy offered, issued or renewed in this Commonwealth
shall provide coverage for hormonal and non-hormonal treatments
for the management of menopausal symptoms. Coverage required
under this section shall include all of the following:
(1) Coverage for all drugs, devices and combination products
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approved by the United States Food and Drug Administration for
the treatment of menopausal symptoms.
(2) Coverage for behavioral therapy that assists individuals
in coping with menopausal symptoms.
(3) Coverage for therapy to treat menopause that has been
induced by a hysterectomy.
(b) Coverage required under this section shall be subject to
the terms and conditions of a health insurance policy, including
provisions relating to medical necessity, cost-sharing and
utilization review.
(c) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Cost-sharing" means:
(1) The share of health care costs covered by 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 balanced bill
amount for an out-of-network provider or the cost of a
noncovered service.
"Health insurance policy" means:
(1) A policy, subscriber contract, certificate or plan that
provides medical or health care coverage on an expense-incurred
or prepaid basis and that is offered by or is governed under any
of the following:
(i) This act, including section 630.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the " Health Maintenance Organization Act ."
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(iii) 40 Pa.C.S. Chs. 61 (relating to hospital plan
corporations) and 63 (relating to professional health services
plan corporations).
(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 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 dental only policy.
(x) A vision only policy.
(xi) A workers' compensation policy.
(xii) An automobile medical payment policy issued under 75
Pa.C.S. (relating to vehicles).
(xiii) A homeowners' insurance policy.
(xiv) Any other similar policy providing for limited
benefits.
"Hysterectomy" means a surgical procedure to remove a woman's
uterus, which may include removal of the cervix, ovaries or
fallopian tubes.
"Menopausal symptoms" means any of the following:
(1) Irregular menstrual periods.
(2) Hot flashes.
(3) Vaginal or bladder changes.
(4) Decreased fertility.
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(5) Loss of bone density, including osteoporosis.
(6) Elevated low-density lipoprotein cholesterol levels.
(7) Sleep disturbances, including night sweats.
"Menopause" means t he permanent cessation of menstruation
resulting from loss of ovarian follicular function,
characterized by the end of ovulation and a decline in estrogen
and progesterone production.
Section 2. This act shall apply as follows:
(1) For a health insurance policy for which either rates
or forms are required to be filed with the Insurance
Department, the addition of section 635.11 of the act shall
apply to a policy for which a form or rate is first filed on
or after the effective date of this paragraph.
(2) For a health insurance policy for which neither
rates nor forms are required to be filed with the Insurance
Department, the addition of section 635.11 of the act shall
apply to a 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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