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SB 1289

An Act providing for patient access to clear health care information; and requiring plain-language summaries of coverage, prior authorization and appeal rights.

2025-2026 Regular Session Introduced by Jarrett Coleman and 2 co-sponsors

The bill requires plain-language summaries of coverage, prior authorization, and appeals to help patients understand benefits and how to obtain or challenge care.

Referred to Health & Human Services
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WeVote Research Nonpartisan
Bill Summary · SB 1289

Summary of SB 1289 (Session 2025-2026) – Pennsylvania

Purpose and Intent

SB 1289 aims to improve patient access to clear, comprehensible health care information. The bill requires that health care coverage information, as well as the processes for prior authorization and appeals, be provided in plain language summaries. The overarching goal is to empower patients to understand their benefits, rights, and the steps available to challenge or obtain coverage for care.

Key Provisions and Changes

  • Plain-Language Summaries of Coverage

    • Health insurance plans and related entities would be required to provide concise, plain-language summaries of coverage, including what services are covered, any limits or exclusions, and the general scope of benefits.
    • These summaries are intended to be easier to understand than standard policy language.

  • Prior Authorization Information

    • The bill mandates plain-language explanations of the prior authorization process, including what types of services typically require authorization, the steps a patient or provider must take, timelines, and expected outcomes.
    • Clear information on how delays or denials are handled within the prior authorization framework would be included.

  • Appeals Rights and Processes

    • Patients would receive plain-language information about appeal rights, the procedures to file an appeal, required documentation, and the timeline for decisions.
    • The summaries would cover levels of appeal and potential next steps if an initial appeal is denied (e.g., external review, further appeals).

  • Delivery and Accessibility

    • Plain-language materials would need to be made readily accessible to patients, potentially via multiple channels (e.g., online portals, mailed summaries, or patient notices).
    • Considerations may include readability standards and avoidance of medical jargon beyond common terms.

  • Scope and Applicability

    • The bill appears to apply to health plans and entities responsible for providing coverage information, including insurers and possibly third-party administrators involved in patient benefit communications.

Affected Parties

  • Patients and Enrollees: Direct beneficiaries who will receive easier-to-understand information about coverage, prior authorization, and appeal rights.
  • Health Insurers and Plans: Especially those obligated to produce plain-language summaries and ensure accessible communications.
  • Healthcare Providers: May gain clearer guidelines for communicating coverage and authorization steps to patients.
  • Payers’ Administrative Entities: Third-party administrators or similar organizations involved in coverage determinations and notifications.

Procedural and Timeline Aspects

  • Status: Referred to the Health & Human Services Committee (as of 2026-04-17).
  • Legislative Path: After referral, the bill would typically proceed to committee hearings, possible amendments, and, if advanced, floor consideration and potential votes in the chamber of origin and the other legislative chamber.
  • Implementation Timeline: Specific effective dates are not provided in the summary, but such bills commonly include a phased-in effective date (e.g., a general effective date within one to two years after enactment) and consider interim guidance or regulations to ensure smooth rollout.

Notable Context

  • The bill is sponsored by multiple lawmakers (co-sponsors: Dawn Keefer, Elder Vogel, and Jarrett Coleman), signaling bipartisan interest in improving consumer-facing health care information.
  • The emphasis on plain-language resources aligns with broader legislative and regulatory efforts to enhance transparency and patient understanding of health care benefits and administrative processes.

If you’d like, I can tailor this summary to a specific audience (e.g., policymakers, health care providers, or patient advocacy groups) or compare SB 1289 to similar transparency measures enacted in other states.

Compiled from official sources — confirm details with the bill’s official record.

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