Current through Pa Acts 2024-53, 2024-56 through 2024-92
Section 1560 - Supervision(a) Except as otherwise provided in this act, a health maintenance organization operating under the provisions of this act shall not be subject to the laws of this State now in force relating to insurance corporations engaged in the business of insurance nor to any law hereafter enacted relating to the business of insurance unless such law specifically and in exact terms applies to such health maintenance organization. For a health maintenance organization established, operated and maintained by a corporation or limited liability company, this exemption shall apply only to the operations and subscribers of the health maintenance organization.(b) All health maintenance organizations shall be subject to the following insurance laws: (1) The act of July 22, 1974 (P.L.589, No.205), known as the "Unfair Insurance Practices Act."(2) Any rehabilitation, liquidation or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation or conservation of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies.(c) All rates charged subscribers or groups of subscribers by a health maintenance organization and the form and content of all contracts between a health maintenance organization and its subscribers or groups of subscribers, all rates of payment to hospitals made by a health maintenance organization pursuant to contracts provided for in this act, budgeted acquisition costs in connection with the solicitation of subscribers, and the certificates issued by a health maintenance organization representing its agreements with subscribers shall, at all times, be on file with the commissioner and be deemed approved unless explicitly rejected within sixty days of filing. Filings shall be made to the commissioner in such form, and shall set forth such information as the commissioner may require to carry out the provisions of this act. Any disapproval of a filing by the commissioner may be appealed in accordance with Title 2 of the Pennsylvania Consolidated Statutes (relating to administrative law and procedure).(d) Solicitors or agents compensated directly or indirectly by a health maintenance organization subject to the provisions of this act shall meet such prerequisites as the commissioner by regulation shall require.(e) A health maintenance organization shall establish and maintain a grievance resolution system satisfactory to the secretary, whereby the complaints of its subscribers may be acted upon promptly and satisfactorily.(f) If a health maintenance organization offers eye care which is within the scope of the practice of optometry, it shall make optometric care available to its subscribers, and shall make the same reimbursement whether the service is provided by an optometrist or a physician.Amended by P.L. 870 2014 No. 96, § 3, eff. 8/31/2014.1972, Dec. 29, P.L. 1701, No. 364, § 10, imd. effective. Affected 1978, April 28, P.L. 202, No. 53, § 2(a) [1462], effective June 27, 1978. Amended 1980, Dec. 19, P.L. 1300, No. 234, § 4, effective in 60 days.