On May 1, 2023, Gov. Shapiro signed Act 1 of 2023 into law. The law requires health insurance carriers in Pennsylvania to cover preventative breast and ovarian cancer screenings for high-risk women at no cost. As of June 30, 2023, the law applies to policies renewed or issued in the state. Employers sponsoring health plans in Pennsylvania should be aware of this development and contact their carriers for further information.

2023 Act 1 - PA General Assembly »

The City of Philadelphia has enacted an ordinance requiring certain employers to offer a commuter transit benefit program to eligible employees effective December 31, 2022. Below is a key summary of the programs.

Effective Date: December 31, 2022

Covered Employers: Employers with 50 or more compensated employees who work on average 30 hours per week within the geographic boundaries of Philadelphia for the same employer within the previous 12 months.

Requirement: Covered employers must make available to all its covered employees at least one of the following employee commuter transit benefit programs:

1. Election of pre-tax payroll deduction for mass transit expense or qualified bicycle expense consistent with the IRC (e.g., reasonable expenses related to the purchase, maintenance, repair and storage of bicycles used for commuting).
2. Employer-provided fare instrument (e.g., any pass, token, fare card or similar item entitling a person to transportation on public transit).
3. Any combination of (1) or (2).

Maximum Limits: At least up to the federal limits (2023: $300/ month).

Penalty: If an employee alleges that the employer failed to comply with the programs, that will trigger an investigation of the employer. If the employer is found to be in violation of the programs, they will have 30 days to comply with the ordinance. Subsequently, if the employer continues to be in violation of the programs, the penalty may be assessed each day that the employer fails to satisfy the program requirements.

The City of Philadelphia Ordinance: Employee Commuter Transit Benefit Programs »

On March 12, 2022, the Department of Insurance published Notice 2022-04. The notice relates to an annual adjustment to the maximum benefit amount for coverage of autism spectrum disorders. According to the notice, for plans/policies issued or renewed in 2023, the maximum benefit is $45,808 (up from $42,811 for plans/policies issued or renewed in 2022). Employers with questions on the maximum benefit should work with their carriers.

Notice 2022-04 »

On March 13, 2021, the Department of Insurance published Notice 2021-03. The notice relates to an annual adjustment to the maximum benefit amount for coverage of autism spectrum disorders. According to the notice, for plans/policies issued or renewed in 2022, the maximum benefit is $42,811 (up from $42,220 for plans/policies issued or renewed in 2021). Employers with questions on the maximum benefit should work with their carriers.

Notice 2021-03 »

On March 6, 2021, the Insurance Department issued Notice 2021-03 reminding insurers of their obligation to provide certain coverage related to COVID-19. The notice also serves as a good reminder for employer plan sponsors of the coverage available under a group health insurance policy issued in Pennsylvania.

• As required by the FFCRA and CARES Act, insurers must provide coverage for COVID-19 testing without cost sharing for the insured when recommended by a health care provider as medically appropriate.
• As required by the CARES Act, insurers must provide coverage for the approved COVID-19 vaccinations without cost sharing for the insured without regard to the network participation status of the health care provider.
• The Insurance Department encourages insurers to be flexible with their telehealth coverage and policies through the end of the public health emergency and communicate any policy changes to insureds 60 days in advance.

Employers with plans issued by the state should be aware of this development.

Notice 2021-03 »

The COVID-19 Emergency Paid Sick Leave Act is a temporary ordinance signed into law on December 9, 2020, and is effective immediately. It will remain in effect until the public health emergency ends. Employers with 50 or more total employees must provide eligible employees with 80 hours of paid COVID-19 sick leave. Eligible employees are those who perform at least 51% of their work in Pittsburgh, including telework. It also includes those that normally work in Pittsburgh, but are teleworking from another location during the pandemic.

Qualified reasons for leave are as follows:

• If a healthcare provider or public health authority or employer determines that an employee would be a health risk to others due to exposure to COVID-19, or due to that employee exhibiting symptoms of COVID-19.
• If an employee must care for a family member due to that family member being determined as a health risk to others due to exposure to COVID-19, or due to that family member showing symptoms of COVID-19.
• If an employee needs to quarantine due to being diagnosed with COVID-19, showing symptoms of COVID-19, or needs to seek diagnosis or other care for COVID-19.
• If an employee must care for a family member who needs to quarantine or otherwise seek treatment/diagnosis under item iii) above.

There is no specific notice requirement, but the best practice would be for employers to inform employees of the availability of this paid leave.

Pittsburgh COVID-19 Emergency Paid Sick Leave FAQs »

HB 427 requires policies issued or renewed on or after October 9, 2020, which provide coverage for the treatment of stage four advanced metastatic cancer to provide coverage for prescription drugs related to the treatment of such cancer. Specifically, the insurer may not require an insured to first fail to successfully respond to a different drug or prove a history of failure with a different drug before providing coverage for a covered drug if it is approved by the FDA is consistent with the best clinical practices for the treatment of stage four advanced metastatic cancer or a related severe adverse health condition.

Employers should be aware of this insurance mandate.

HB427 »

On March 20, 2020, the City of Philadelphia announced expansions to its paid sick leave law relating to COVID-19. Specifically, during the COVID-19 risk, covered employees can use accrued paid sick leave time for mandated business closures, caring for children during school or childcare closures, official or self-quarantine, and illness and treatment of an illness for an individual and their family member. In addition, employees are not required to provide a note from a medical professional in order to use consecutive paid sick leave during the COVID-19 risk.

Employers with Philadelphia employees should review the announcement and work with outside counsel in updating their leave policies to reflect the ability of employees to use accrued paid sick leave for the above COVID-19 reasons

Announcement »
Updated FAQs »
Updated Guidelines »

On March 19, 2020, the Insurance Department published Notice 2020-4. The bulletin encourages carriers to assist employers (and other policyholders) who have been negatively impacted by the COVID-19 pandemic by relaxing due dates for premium payments, extending grace periods, waiving late fees and penalties and allowing payment plans for premium payments to otherwise avoid a lapse in coverage. The bulletin directs carriers to consider cancellation or nonrenewal of policies only after exhausting other efforts to work with employers (and other policyholders) to continue coverage.

Employers with fully insured plans in Pennsylvania that may need assistance with premium payments should contact and discuss the issue with their carrier.

Notice 2020-4 »

On March 7, 2020, the Department of Insurance published Notice Number 2020-02. The notice relates to an annual adjustment to the maximum benefit amount for coverage of autism spectrum disorder. According to the notice, for plans/policies issued or renewed in 2021 the maximum benefit is $42,220 (up from $41,271 for plans/policies issued or renewed in 2020). Employers with questions on the maximum benefit should work with their carriers.

Notice Number 2020-02 »