Health plans - Pennsylvania

Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).

Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, do apply.

On July 14, 2005, House Bill 107 was signed, allowing a high deductible health plan (HDHP) under section 223(c) of the Internal Revenue Code,  when offered in conjunction with a health savings account (HAS), to not be subject to any provision of law which restricts or limits deductibles for mandated minimum health insurance benefits or reimbursements except to the extent such provision mandates benefits for preventive care.

Act 4 of 2009 (SB 189), signed into law June 10, 2009, allows adults up to age 30, under certain conditions, to remain covered by their parents’ health insurance.

The eligible children must meet the following criteria:

• Be unmarried
• Have no dependents
• Be residents of the commonwealth or enrolled as a fulltime student at an institution of higher education and
• Do not have private insurance coverage or enrolled in, or eligible for, government benefits.

The coverage expansion occurs at the discretion of the employer and does not preclude an increase in premiums related to covering children for these additional years.

State

Contact

Pennsylvania Insurance Department

Regulations

Pennsylvania Statutes

Title 40 Insurance

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

29 CFR chapter XXV (Parts 2509 – 2590)