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 cost-sharing calculation.

PRINTER'S NO. 221
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 268
Session of
2025
INTRODUCED BY J. WARD, COLLETT, BROOKS, PENNYCUICK, FONTANA,
BARTOLOTTA, COMITTA, KEARNEY, TARTAGLIONE, SCHWANK,
SANTARSIERO AND FARRY, FEBRUARY 20, 2025
REFERRED TO BANKING AND INSURANCE, FEBRUARY 20, 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 cost-sharing calculation.
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 631.2. Cost-Sharing Calculation.--(a) When
calculating an insured's contribution to an applicable cost-
sharing requirement under a health insurance policy:
(1) The insurer shall include any cost-sharing amounts paid
by the insured or on behalf of the insured by another person.
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(2) A pharmacy benefits manager that administers pharmacy
benefits for the insurer shall include any cost-sharing amounts
paid by the insured or on behalf of the insured by another
person.
(b) This section shall apply to a health insurance policy
issued or entered into or renewed on or after the effective date
of this section.
(c) As used in this section:
"Cost-sharing" means the cost to an individual insured under
a health insurance policy according to a coverage limit,
copayment, coinsurance, deductible or other out-of-pocket
expense requirements imposed by the policy, contract or
agreement.
"Covered entity" means a contract holder or policy holder
providing pharmacy benefits to a covered individual under a
health insurance policy pursuant to a contract administered by a
pharma cy benefits m anager.
"Health insurance policy" means:
(1) An individual or group health, sickness or accident
policy, or subscriber contract or certificate offered, issued or
renewed by an entity subject to one of the following:
(i) This act.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(2) The term does not include accident only, fixed
indemnity, hospital indemnity, limited benefit, credit, dental,
vision, specified disease, Medicare supplement, Civilian Health
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and Medical Program of the Uniformed Services (CHAMPUS)
supplement, long-term care or disability income, workers'
compensation or automobile medical payment insurance.
"Pharmacy benefits manager" means a person, business or other
entity that performs pharmacy benefits management for covered
entities.
Section 2. This act shall take effect in 60 days.
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