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.
SB1195, the Health Insurance Preventive Services Coverage Act, would require most Pennsylvania health insurance policies to cover a defined list of preventive services without cost sharing. The covered services would generally track preventive care already required under federal law for individual market plans as of January 1, 2025, including evidence-based services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, and certain women’s, infant, child, and adolescent preventive services. The bill excludes grandfathered plans and several limited-benefit policies, and it allows insurers to continue using value-based insurance designs and reasonable medical management techniques.
The bill also gives the Insurance Department authority to maintain and update the preventive services list through a notice-and-comment process. The department could add services that meet the bill’s evidence-based standards or exempt services that no longer qualify, while considering public comments, cost impacts, access, scientific developments, and potential discrimination concerns. Any changes would be published in the Pennsylvania Bulletin and posted online, and affected parties could appeal departmental actions to the Insurance Commissioner and then to Commonwealth Court.
SB1195 would affect Pennsylvania insurance law by creating a state-level preventive services coverage mandate and enforcement framework. It authorizes the commissioner to impose penalties for violations, including license suspension or revocation and civil fines, and it treats violations as unfair insurance practices under existing law. The bill also includes a contingency structure: it is designed to function as a substitute state coverage requirement if the federal preventive services mandate in 42 U.S.C. § 300gg-13 is repealed, invalidated, or not enforced.
The overall sentiment reflected in the bill text is supportive of preserving and protecting preventive care coverage, with a strong consumer-protection orientation. Because there are no committee transcripts or recorded votes provided, there is no documented debate or formal voting history to indicate broader legislative sentiment beyond the sponsors’ intent. The bill’s structure suggests an effort to ensure continuity of coverage and limit out-of-pocket costs for preventive care.
The main points of contention likely involve the scope of the mandate, the Insurance Department’s authority to add or exempt services, and the potential cost effects on insurers and premiums. Network adequacy issues may also be disputed, since the bill generally does not require out-of-network coverage except when no in-network provider can furnish the service. Religious freedom exemptions and the bill’s reliance on federal preventive-services standards could also be areas of concern for opponents or stakeholders.
The bill would create a new chapter of Pennsylvania insurance requirements mandating no-cost preventive services coverage for most health insurance policies, while excluding grandfathered plans and certain limited-benefit products. It would expand the Insurance Department’s regulatory role by authorizing it to maintain the preventive services list, issue notices, accept public comment, and enforce compliance through administrative penalties. It would also incorporate existing federal preventive-care standards by reference and provide a state substitute framework if the federal mandate changes.
The bill appears generally favorable toward expanded preventive care access and consumer protection, with sponsors positioning it as a safeguard against loss of federal preventive-services coverage. No committee discussion or vote record was provided, so there is no direct evidence of opposition or support from hearings or floor action. Based on the text alone, the measure is framed as a protective, continuity-focused insurance reform rather than a controversial policy shift.
Likely areas of contention include whether the preventive-services mandate could raise insurance costs, how much discretion the Insurance Department should have to add or exempt services, and whether the bill could affect insurer benefit design or premium levels. Insurers may also object to the requirement to cover out-of-network preventive services when no in-network provider is available, while religious liberty exemptions and the bill’s dependence on federal standards may draw scrutiny from both supporters and opponents. The bill explicitly tries to address some of these concerns by allowing medical management, preserving other cost-sharing limits, and limiting implementation to the extent needed if federal law changes.