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 coverage for dyslexia.

PRINTER'S NO. 1107
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 967
Session of
2025
INTRODUCED BY MUTH, HUGHES, HAYWOOD, FONTANA, COSTA, SAVAL AND
KANE, AUGUST 13, 2025
REFERRED TO BANKING AND INSURANCE, AUGUST 13, 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 coverage for dyslexia.
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. Coverage for Dyslexia.--(a) Every health
insurance policy offered, issued or renewed in this Commonwealth
shall provide coverage for physician services and medical, major
medical or similar comprehensive-type coverage for testing for
suspected dyslexia in accordance with this section and shall not
exclude coverage for the screening, diagnosis or treatment of
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medical conditions otherwise covered by the policy. The
following shall apply:
(1) Coverage shall include comprehensive neuropsychological
examinations for the purposes of diagnosing dyslexia, pursuant
to this subsection.
(2) A clinician's neuropsychological report shall include
comprehensive recommendations regardless of diagnosis, including
a psychological, emotional and educational wellness plan for the
individual evaluated.
(b) Coverage under this subsection is only required if one
or more of the following criteria are met:
(1) The insured is at an increased hereditary risk for
dyslexia owing to a family history of dyslexia.
(2) The individual is a student who:
(i) has failed the following number of readily available
literacy screening benchmarks of proven psychometric value:
(A) two, if in kindergarten or first grade; or
(B) one, if in second grade or above; and
(ii) is deemed at-risk according to their instructor, school
or other supervising educational body.
(3) The individual's pediatrician identifies the individual
as at-risk for dyslexia as indicated by findings from a valid
and reliable screener and recommends a neuropsychological
examination; or
(4) The individual is a student with a history of risk
factors known to impact learning and educational outcomes,
including fetal toxin exposure, prematurity or a history of
neurological disorders, such as epilepsy.
(c) Coverage required by subsection (a) shall be capped at
six thousand dollars ($6,000) per year, indexed to inflation to
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be adjusted every two years according to the United States
Department of Labor Consumer Price Index for All Urban Consumers
(CPI-U), for the calendar year preceding the calendar year in
which the adjustment to the maximum benefit amount is
promulgated by the department.
(d) This section shall not apply to the following types of
policies:
(1) Accident only.
(2) Limited benefit.
(3) Credit.
(4) Dental.
(5) Vision.
(6) Specified disease.
(7) Medicare supplement.
(8) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(9) Long-term care or disability income.
(10) Workers' compensation.
(11) Automobile medical payment.
(e) (1) The term "health insurance policy" when used in
this section means any individual or group health insurance
policy, subscriber contract, certificate or plan that provides
medical or health care coverage by any health care facility or
licensed health care provider that is offered by or is governed
under this act or any of the following:
(i) Subarticle (f) of Article IV of the act of June 13, 1967
(P.L.31, No.21), known as the "Human Services Code."
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) The act of May 18, 1976 (P.L.123, No.54), known as the
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"Individual Accident and Sickness Insurance Minimum Standards
Act."
(iv) The former act of December 14, 1992 (P.L.835, No.134),
known as the "Fraternal Benefit Societies Code."
(v) A nonprofit corporation subject to 40 Pa.C.S. Chs. 61
(relating to hospital plan corporations) and 63 (relating to
professional health services plan corporations).
(2) The term "insurer" when used in this section means any
entity that issues an individual or group health insurance
policy, contract or plan described under clause (1) of this
subsection.
Section 2. This act shall take effect in 60 days.
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