HB 1244 — 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 pelvic floor therapy.

PRIOR PRINTER'S NO.

1393 THEPRINTER'S GENERALNO. ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.

3946 THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.

WILLIAMS, KENYATTA, SHUSTERMAN, STEELE, HOHENSTEINHOHENSTEIN, GREEN, ISAACSON, BOYD AND GREEN,TIBURCIO, APRIL 17, 2025 REFERREDAS TOREPORTED FROM COMMITTEE ON INSURANCE,AGING APRILAND 17,OLDER 2025ADULT ANSERVICES, ACTHOUSE AmendingOF theREPRESENTATIVES, actAS ofAMENDED, MaySEPTEMBER 17,29, 19212026 (P.L.682,AN No.284),ACT entitledAmeact "An act relating to insurance;

amending, revising, andandntitled "An 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;

Coverage for Pelvic Floor Therapy.--(a) A government program offered or a health insurance policy THAT IS <-- OFFERED, issued or renewed on or after the effective date of this subsection shall provide coverage for the diagnosis and treatment of pelvic floor dysfunction and linked or related conditions, including:

(b) Coverage under this section shall remain BE subject to <-- an insurer's or government program's medical necessity policies, <-- any copayment, coinsurance or deductible amounts stated in the policy.

(c)ALL AsOF usedTHE inFOLLOWING: this section, the following words and phrases shall have the meanings given to them in this subsection unless the context clearly indicates otherwise:

<-- (1) ARTICLE XXI.

(2) THE TERMS AND CONDITIONS OF THE HEALTH INSURANCE POLICY, INCLUDING DETERMINATIONS OF MEDICAL NECESSITY AND CLINICAL REVIEW CRITERIA USED FOR UTILIZATION REVIEW OF HEALTH CARE SERVICES, COPAYMENT PROVISIONS, DEDUCTIBLE PROVISIONS AND COINSURANCE PROVISIONS.

(C) SUBJECT TO FEDERAL APPROVAL, AS NECESSARY, BEGINNING JANUARY 1, 2028, A MEDICAL ASSISTANCE OR CHILDREN'S HEALTH INSURANCE PROGRAM MANAGED CARE PLAN SHALL PROVIDE COVERAGE FOR THE DIAGNOSIS AND TREATMENT OF PELVIC FLOOR DYSFUNCTION AND LINKED OR RELATED CONDITIONS, SUBJECT TO:

(1) ARTICLE XXI.

(2) APPLICABLE FEDERAL LAWS AND REGULATIONS.

(3) APPLICABLE STATE LAWS AND REGULATIONS.

(4) THE TERMS AND CONDITIONS OF AN AGREEMENT WITH THE DEPARTMENT OF HUMAN SERVICES, INCLUDING DETERMINATIONS OF MEDICAL NECESSITY AND CLINICAL REVIEW CRITERIA USED FOR 20250HB1244PN3946 - 2 - UTILIZATION REVIEW OF HEALTH CARE SERVICES ALONG WITH COPAYMENT, DEDUCTIBLE AND COINSURANCE PROVISIONS.

(c) (D) As used in this section, the following words and <-- phrases shall have the meanings given to them in this subsection unless the context clearly indicates otherwise:

<-- (1) The Commonwealth's medical assistance program established under the act of June 13, 1967 (P.L.31, No.21), known as the "Human Services Code." (2) The children's health insurance program under Article XXIII-A.

20250HB1244PN1393"HEALTH -INSURANCE 2POLICY" -MEANS "Insurer"A meansPOLICY, anSUBSCRIBER entity<-- licensedCONTRACT, byCERTIFICATE theOR InsurancePLAN DepartmentISSUED thatBY offers,A issuesHEALTH orINSURER renewsTHAT anPROVIDES individualMEDICAL orOR groupHEALTH healthCARE insuranceCOVERAGE. policy that is offered or governed under any of the following:

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.

20250HB1244PN3946 - 3 - (6) A FIXED INDEMNITY POLICY.

(7) A HOSPITAL INDEMNITY POLICY.

(8) A DENTAL ONLY POLICY.

(9) A VISION ONLY POLICY.

(10) A WORKERS' COMPENSATION POLICY.

(11) AN AUTOMOBILE MEDICAL PAYMENT POLICY.

(12) A POLICY UNDER WHICH BENEFITS ARE PROVIDED BY THE FEDERAL GOVERNMENT TO ACTIVE OR FORMER MILITARY PERSONNEL AND THEIR DEPENDENTS.

(13) ANY OTHER SIMILAR POLICY PROVIDING FOR LIMITED BENEFITS.

"Insurer" means an entity licensed by the Insurance Department that offers, issues or renews an individual or group health insurance policy that is offered or governed under any of the following:

The addition of section 635.11 of the act shall 20250HB1244PN3946 - 4 - apply as follows:

20250HB1244PN1393 - 3 - Section 3.

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