PA HB535

Prohibits health insurers from imposing annual or lifetime dollar limits on core benefits for enrollees in individual or group health insurance policies, whether services are provided by in-network or out-of-network providers

Defines "core benefits" as those benefits that were not subject to annual or lifetime limits in Pennsylvania individual or small group policies in plan year 2025

Establishes penalties for violations including license suspension/revocation, fines up to $5,000 per violation (or $10,000 for willful violations), with aggregate annual caps of $500,000 for insurers and $100,000 for other persons

Creates a contingency mechanism that activates the state law if the federal prohibition on lifetime/annual limits (42 U.S.C. § 300gg-11) is repealed, invalidated by courts, or not enforced by the executive branch

Requires the Insurance Commissioner to publish notice in the Pennsylvania Bulletin if any triggering event occurs affecting the federal lifetime/annual limits prohibition