Bill In PA House Would Bar Insurers From Changing Benefits Mid-Year

May 1, 2018

Legislation in the Pennsylvania House would prohibit health insurance companies from changing benefits or adding restrictions to coverage plans mid-year.

Pennsylvanians for Fair Health Coalition, a proponent of the bill, argues the legislation is necessary, because right now, a patient’s coverage can change due to “non-medical decisions made by insurance companies.”   

Gretchen Knaub, Harrisburg area regional director for the Epilepsy Foundation of Western-Central Pennsylvania, testified during a hearing of the Consumers Affairs Committee on Monday in favor of the bill. Knaub said a mother her organization serves became worried after her daughter started experiencing involuntary ticks, which can be indicative of seizures.

“So concerned, her mother checked and found that the pills had been switched,” Knaub said. “It had been ordered by her family’s health insurer in the middle of the policy year. Unfortunately, they did not tell the parent or her doctor. After a long appeal, she was able to get the company to give her daughter [the original] medication, however they are charging her four times what they had been charging her previously."

Most health insurance contracts last 12 months, and opponents of the bill say insurance companies need flexibility to keep pace with the latest developments in medical science. They complain this legislation would hinder that.

“It’s not something static. Here on January 1, we know this,” said Sam Marshall, president and CEO the Insurance Federation of Pennsylvania.  “Anything we learn over the next 12 months, we don’t apply until the next January 1. Doesn’t make sense. You should evolve.”

The legislation has bipartisan support. Cosponsors include Westmoreland County Republican Eric Nelson, and Democrats William Kortz and Robert Matzie, who both represent portions of Allegheny County.

Proto Credit: Feggy Art/Flickr