Co-Sponsorship Memo Details

In the near future, I plan to re-introduce legislation amending Pennsylvania’s Unfair Insurance Practices Act to prohibit health insurers from altering the coverage or premiums included in an insured person’s health insurance policy during the policy term when an insured person has already received a specific treatment, service or prescription drug.

Many of us have encouraged our constituents to take control of their own health care needs by becoming diligent and smart shoppers in the health insurance marketplace. We urge them to find a plan that provides needed coverage, including products, services, procedures, treatments and prescription drugs at a price they can afford. But what good does that do for our constituents if the health insurer can change its contract terms at any point during a contract year? The result is that insured people are left with little recourse and are forced to pay higher out-of-pocket costs for a benefit that was supposed to be covered, or they lose coverage of that benefit altogether. I have heard from many patients and providers throughout the Commonwealth expressing their frustration and negative experiences when a health insurer fails to honor its contract. My legislation will end this practice.

My legislation is modeled after "Principle Number 5" of the American Medical Association, Prior Authorization and Utilization Management Reform Principles document. The policy principles are supported by such groups as the American Hospital Association, American Pharmacists Association, the American College of Cardiology and many other stakeholders.

This legislation provides protection for patients who are already receiving a benefit within the policy year of their health insurance contract. It does not impact an insurer’s ability to alter covered benefits for insured people who are not already receiving a specific service, treatment or prescription drug. Finally, this legislation does not apply to a benefit removed from coverage because it has been deemed unsafe by the FDA or when production of a prescription drug has been discontinued.

I understand and support the important role health care insurers play in administering health care benefits in a cost-effective manner. But I equally believe our constituents should get the coverage they paid for and have continued access to services and prescription drugs that are successfully treating their ailments.

Please join me in co-sponsoring this important legislation.