An Act providing for health care insurance coverage protections; imposing duties on the Insurance Department and the Insurance Commissioner; and imposing penalties.
Summary
HB535, titled the Health Insurance Protection Against Limitations Act, would prohibit insurers from placing annual or lifetime dollar limits on “core benefits” in individual and group health insurance policies. The bill applies to health insurance coverage offered, issued, or renewed by insurers regulated under Pennsylvania insurance law, including traditional insurers, HMOs, hospital plan corporations, and professional health services plan corporations. It defines core benefits by reference to benefits that could not be subject to annual or lifetime per-enrollee limits in Pennsylvania’s 2025 small-group and individual market.
The bill does not require insurers to cover any specific service. Instead, it bars caps on the dollar value of covered core benefits, whether the care is received in-network or out-of-network. It also directs the Insurance Department to adopt regulations as needed and gives the Insurance Commissioner authority to enforce the act through license suspension or revocation, fines, and other penalties. The bill includes a trigger mechanism: if the federal no-lifetime-or-annual-limits law is repealed, invalidated, or not enforced, Pennsylvania’s protections would continue as a substitute coverage requirement to the extent necessary.
Impact
HB535 would add a state-law backstop to federal protections against annual and lifetime limits on health benefits, making those protections part of Pennsylvania insurance regulation and enforcement. It would affect individual and group health insurance policies regulated by the Commonwealth, while excluding many limited-benefit products such as dental-only, vision-only, Medicare supplement, workers’ compensation, and certain indemnity policies. The bill also ties violations to existing insurance enforcement frameworks, including the Unfair Insurance Practices Act, and authorizes administrative penalties and judicial review.
Sentiment
The available voting history suggests the bill had meaningful support but also notable opposition. It advanced out of the House Insurance Committee on a 14-12 vote and later passed the House floor by a wider 121-81 margin, indicating majority support but not broad consensus. The committee and floor votes together suggest the measure was viewed favorably by supporters as a consumer-protection and coverage-stability bill, while opponents were sufficiently concerned to vote against it in substantial numbers.
Contention
The main point of contention is the scope of state regulation over health insurance and whether Pennsylvania should codify a protection that largely mirrors federal law. Supporters appear to favor preserving coverage protections against annual and lifetime caps, especially as a safeguard if federal law changes. Opponents likely object to the added regulatory burden, potential premium impacts, or the need for a state-level substitute requirement. Another possible area of debate is the bill’s broad application to both in-network and out-of-network benefits and its enforcement penalties, which give the Insurance Commissioner significant authority.
Providing for health care insurance coverage protections, for duties of the Insurance Department and the Insurance Commissioner, for regulations, for enforcement and for penalties.
Providing for health care insurance coverage protections, for duties of the Insurance Department and the Insurance Commissioner, for regulations, for enforcement and for penalties.
Providing for access to contraceptives; imposing duties on the Insurance Department and the Department of Human Services; providing for severability; and imposing penalties.
Providing for access to contraceptives; imposing duties on the Insurance Department and the Department of Human Services; providing for severability; and imposing penalties.
Providing for health care insurance preventive services coverage protections; conferring authority on the Insurance Department and the Insurance Commissioner; and providing for regulations, for enforcement and for penalties.
Providing for health care insurance preventive services coverage protections; conferring authority on the Insurance Department and the Insurance Commissioner; and providing for regulations, for enforcement and for penalties.
Providing for individual and group health care insurance coverage protections and for core health benefits; imposing penalties; and providing for applicability and for regulations.