By: Jenny Bender, MPH, BSN, RN, CIC – Chair, Allegheny County Immunization Coalition
Access to immunizations is one of the strongest tools we have for preventing disease and promoting public health. In Pennsylvania, two companion bills—House Bill 1828 and Senate Bill 989—aim to strengthen vaccine access by ensuring consistent insurance coverage and eliminating financial barriers for patients.
Here’s a breakdown of what these bills would do and why they matter for healthcare leaders, clinicians, and patients across the Commonwealth.
Core Purpose
Both HB 1828 and SB 989 amend Title 40 of the Pennsylvania Consolidated Statutes (Insurance). Their shared goal:
- Require most health insurers to cover immunizations recommended by the PA Department of Health in the wake of potentially changing federal recommendations.
- Eliminate patient cost-sharing for vaccines delivered by in-network providers.
- Establish a clear framework for enforcement and penalties if insurers fail to comply.
Key Provisions of the Proposed Legislation
- Coverage of Immunizations
- Health insurance policies (with the exception of grandfathered plans) would be required to cover immunizations.
- Patients could not be charged copays, deductibles, or coinsurance for vaccines administered in-network.
- Role of the Pennsylvania Department of Health
- The PA Department of Health would have authority to add or remove immunizations from the required coverage list.
- Additions could be based on CDC Advisory Committee on Immunization Practices (ACIP) recommendations or on strong scientific evidence from groups like the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG).
- Out-of-Network Coverage Rules
- Insurers could apply cost-sharing if patients choose out-of-network providers.
- However, if no in-network provider is reasonably available, insurers must cover out-of-network immunizations at no additional cost.
- Enforcement and Penalties
- The Insurance Commissioner would oversee compliance.
- Penalties for violations include fines (up to $10,000 per willful violation, capped at $500,000 annually) and potential suspension or revocation of an insurer’s license.
Why This Matters for Healthcare Professionals and their Patients
- Improved Patient Access: By removing financial barriers, more Pennsylvanians could receive recommended immunizations and reduce preventable illness.
- Alignment with Clinical Guidance: Coverage would ensure patients have access to the latest evidence-based immunizations.
- Insurance Navigation: Understanding these requirements will help providers advocate for their patients and address coverage questions at the point of care.
Where Things Stand
- HB 1828 (sponsored by Allegheny County’s own Rep. Arvind Venkat, MD) was introduced in August 2025 and referred to the House Insurance Committee.
- SB 989 (sponsored by Sen. Maria Collett) was introduced in September 2025 and referred to the Senate Banking & Insurance Committee.
- Both bills are in early stages, but if enacted, they would create uniform expectations for immunization coverage statewide.
- PAMED strongly supports House Bill 1828 and commends its sponsors for prioritizing the health and safety of our communities. As physicians, we understand the critical role immunizations play in preventing disease and safeguarding vulnerable populations. PAMED will continue to advocate for policies that uphold access to evidence-based care for all Pennsylvanians.
What You Can Do
Reach out to your local legislators to share your support of this legislation (find your local legislator on PAMED’s website by entering your zip code). Y