An Act providing for health care insurance coverage protections, for duties of the Insurance Department and the Insurance Commissioner, for regulations, for enforcement and for penalties.

PRINTER'S NO. 96
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 52
Session of
2025
INTRODUCED BY HUGHES, KIM, BOSCOLA, CAPPELLETTI, COLLETT,
COMITTA, COSTA, FLYNN, FONTANA, HAYWOOD, KANE, KEARNEY,
MILLER, MUTH, PISCIOTTANO, SANTARSIERO, SAVAL, SCHWANK,
STREET, TARTAGLIONE, A. WILLIAMS AND L. WILLIAMS,
JANUARY 22, 2025
REFERRED TO BANKING AND INSURANCE, JANUARY 22, 2025
AN ACT
Providing for health care insurance coverage protections, for
duties of the Insurance Department and the Insurance
Commissioner, for regulations, for enforcement and for
penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Health
Insurance Protection Against Limitations Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Department." The Insurance Department of the Commonwealth.
"Enrollee." A policyholder, subscriber, covered person or
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
other individual who is entitled to receive health care services
under a health insurance policy.
"Group health insurance policy." A policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to
individuals who obtain health insurance coverage through a
group.
"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.
(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) Any other similar policies providing for limited
benefits.
"In-network provider." A provider who contracts with an
insurer to provide health care services to an enrollee under a
health insurance policy.
"Individual health insurance policy." A policy, subscriber
20250SB0052PN0096 - 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
contract, certificate or plan issued by an insurer that provides
medical or health care coverage on an annual basis to an
individual other than in connection with a group.
"Insurer." An entity that offers, issues or renews an
individual or group health insurance policy that provides
medical or health care coverage by a health care facility or
licensed health care provider and that is governed under any of
the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV thereof.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Out-of-network provider." A provider who does not contract
with an insurer to provide health care services to an enrollee
under a health insurance policy.
Section 3. Limitation on annual and lifetime limits.
(a) Limits.--Except as otherwise provided in this section,
an insurer offering, issuing or renewing an individual or group
health insurance policy may not establish, on either an annual
or lifetime basis, a limit on the dollar value of any core
benefit for an enrollee, whether provided by an in-network
provider or out-of-network provider.
(b) Core benefit.--For purposes of this section, a core
benefit shall include:
(1) A benefit for which no annual or lifetime per
20250SB0052PN0096 - 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
enrollee limit was permitted to be included in an individual
or small group policy first offered or issued in this
Commonwealth in 2018.
(2) A benefit hereafter specified by the department by
regulation.
(c) Benefits not subject to limitation.--The commissioner
may promulgate regulations to exempt a benefit from the
definition of core benefit under subsection (b) for the purposes
of the limitation prohibitions under this section.
(d) No coverage requirement.--This section shall not be
construed to require coverage of any specific benefit.
Section 4. Regulations.
(a) Authority to promulgate.--The department may promulgate
regulations as may be necessary and appropriate to carry out the
provisions of this act.
(b) Temporary regulations.--
(1) In order to facilitate the prompt implementation of
this act, the department may issue temporary regulations
which shall expire no later than two years following
publication of the temporary regulations in the Pennsylvania
Bulletin. The temporary regulations shall be exempt from the
following:
(i) Section 612 of the act of April 9, 1929
(P.L.177, No.175), known as The Administrative Code of
1929.
(ii) Sections 201, 202, 203, 204 and 205 of the act
of July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(iii) Section 204(b) of the act of October 15, 1980
(P.L.950, No.164), known as the Commonwealth Attorneys
20250SB0052PN0096 - 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
Act.
(iv) The act of June 25, 1982 (P.L.633, No.181),
known as the Regulatory Review Act.
(2) The authority of the department to issue temporary
regulations under this subsection shall expire two years from
the effective date of this section. Regulations adopted after
the two-year period shall be promulgated as provided by
statute.
Section 5. Enforcement.
(a) Penalties.--Upon satisfactory evidence of the violation
of any section of this act by an insurer or any other person,
one or more of the following penalties may be imposed at the
commissioner's discretion:
(1) Suspension or revocation of the license of the
offending insurer or other person.
(2) Refusal, for a period not to exceed one year, to
issue a new license to the offending insurer or other person.
(3) A fine of not more than $5,000 for each violation of
this act.
(4) A fine of not more than $10,000 for each willful
violation of this act.
(b) Limitation.--
(1) Fines imposed against an individual insurer under
this act may not exceed $500,000 in the aggregate during a
single calendar year.
(2) Fines imposed against any other person under this
act may not exceed $100,000 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
20250SB0052PN0096 - 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
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. Violations of this act
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 section 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 6. Repeals.
All acts and parts of acts are repealed insofar as they are
inconsistent with this act.
Section 7. Applicability.
This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Insurance
Department, this act shall apply to any policy for which a
form or rate is first filed on or after the effective date of
this section.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Insurance
20250SB0052PN0096 - 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
Department, this act shall apply to any policy issued or
renewed on or after 180 days after the effective date of this
section.
Section 8. Effective date.
This act shall take effect immediately.
20250SB0052PN0096 - 7 -
1
2
3
4
5