Pennsylvania Insurance Department Newsroom · October 27, 2026 · Primary source
Shapiro Administration Releases Health Insurance Transparency Resources Ahead of Open Enrollment
Summary
The Pennsylvania Insurance Department released its 2026 Transparency in Coverage Report and Quality Health Plans Summary Report on October 27, 2026, ahead of Pennie's open enrollment period. The TiC Report shows that individual market claim denials rose from 14.8% to 17.35%, pre-service prior authorization denials reached 17.5% statewide, and fewer than 1% of denied claims or prior authorization requests are appealed despite significant overturn rates. The QHP Summary Report documents PID's annual compliance review of commercial market health plans for compliance with state and federal law, including mental health parity and network adequacy.
What this may mean
The reports document PID's regulatory scrutiny of health plan performance on claims denials, appeals, prior authorization, mental health parity, and network adequacy for the Pennsylvania individual market. The disclosure of a 17.5% prior authorization denial rate and low appeal utilization signals areas of ongoing regulatory focus that could prompt corrective action or targeted market conduct reviews by PID. Network adequacy findings with rural county access gaps are flagged for ongoing monitoring and insurer corrective action.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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