Vote Smart's Synopsis:

Vote to pass a bill that prohibits health insurers from denying coverage based on pre-existing health conditions in Pennsylvania.

Highlights:

• Defines “preexisting condition” as a health condition present before the date of enrollment in or denial of coverage, whether or not any medical care was recommended or received prior to that date (Sec. 2).

• Defines “health factor” as any of the following elements related to an individual’s physical or mental makeup (Sec. 2):

• Health status;

• Medical condition;

• Claims experience;

• Receipt of health care;

• Medical history;

• Genetic information;

• Evidence of insurability, including conditions arising out of domestic violence; or

• Disability. 

• Prohibits health insurers from imposing any rule for initial or continued eligibility of an individual for a health insurance policy based on a preexisting condition or health factor, including that of a dependent (Sec. 3).

• Prohibits health insurers from charging a premium rate that is greater than the premium rate for a similarly situated individual based on any preexisting condition or health factor, including that of a dependent (Sec. 3).

• Prohibits health insurers from excluding or denying particular benefits for individuals based on a preexisting condition or health factor, including that of a dependent (Sec. 3).

• Authorizes health insurers to charge premium rates for a particular plan based on the following factors (Sec. 4):

• Family size;

• Geographic rating area;

• Age, with a premium cap of 3:1; and

• Tobacco use, with a premium cap of 1.5:1.

Full Bill Text