40 Pa. Cons. Stat. § 991.2112. Financial incentives prohibition: Managed Care Plan Requirements – Pennsylvania
Status: Enacted Year Enacted: 1998
No managed care plan shall use any financial incentive that compensates a health care provider for providing less than medically necessary and appropriate care to an enrollee. Nothing in this section shall be deemed to …
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40 Pa. Cons. Stat. § 991.2113. Medical gag clause prohibition: Managed Care Plan Requirements – Pennsylvania
Status: Enacted Year Enacted: 1998
Statute that prohibits medical gag clauses.
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40 Pa. Cons. Stat. § 991.2151. Certification: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
A utilization review entity may not review health care services delivered or proposed to be delivered in this Commonwealth unless the entity is certified by the department to perform utilization review.
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40 Pa. Cons. Stat. § 991.2152. Operations standards: Utilization Review – Pennsylvania
Status: Enacted Year Enacted: 1998
Outlines requirements for an entity to perform utilization review.
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40 Pa. Cons. Stat. § 991.2162. External grievance process: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
A managed care plan shall establish and maintain an external grievance process by which an enrollee or a health care provider with the written consent of the enrollee may appeal the denial of a grievance …
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40 Pa. Cons. Stat. § 991.2182. Penalties and sanctions: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
A managed care plan shall be subject to the act of July 22, 1974 (P.L. 589, No. 205), known as the “Unfair Insurance Practices Act.” The department or the Insurance Department may maintain an action …
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40 Pa. Cons. Stat. §§ 1, 41-61 – Pennsylvania
Status: Enacted
Is the authorizing legislation for the Insurance Department.
40 Pa. Cons. Stat. §§ 3801 through 3806: Retroactive Denial of Reimbursements – Pennsylvania
Status: Enacted Year Enacted: 2016
An insurer that retroactively denies reimbursement to a health care provider under this chapter shall do so based upon coding guidelines and policies in effect at the time the service subject to the retroactive denial …
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40 Pa. Cons. Stat. §§ 6101 through 6127: Hospital Plan Corporations – Pennsylvania
Status: Enacted Year Enacted: 1972
Governs nonprofit hospital plans and includes provisinos such as certification of hospital plan corporations, exemptions, eligible hospitals, and rates and contracts.
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40 Pa. Cons. Stat. §§ 6301 through 6335: Professional Health Services Plan Corporations – Pennsylvania
Status: Enacted Year Enacted: 1972
Provisions governing the regulation of professional health services plan corporations.
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40 Pa. Cons. Stat. §§ 9101 through 9103: Health Insurance Markets Oversight — Preliminary Provisions – Pennsylvania
Status: Enacted Year Enacted: 2019
Provides the Commonwealth intends to maintain the Commonwealth’s sovereignty over the regulation of health insurance in this Commonwealth and defines terms for health insurance markets oversight.
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40 Pa. Cons. Stat. §§ 9301 through 9314: Health Insurance Markets Oversight — State-Based Exchange – Pennsylvania
Status: Enacted Year Enacted: 2019
This chapter relates to the Pennsylvania Health Insurance Exchange Authority. The provisions of this part are intended to meet these requirements while retaining the Commonwealth’s authority to regulate health insurance in this Commonwealth.
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40 Pa. Cons. Stat. §§ 9501 through 9516: Health Insurance Markets Oversight — Reinsurance Program – Pennsylvania
Status: Enacted Year Enacted: 2019
Contingent upon Federal approval, the Commonwealth Health Insurance Reinsurance Program is established in the department for the purposes of stabilizing the rates and premiums for health insurance policies in the individual market and providing greater …
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40 Pa. Cons. Stat. §§ 9701 through 9703: Health Insurance Markets Oversight — Reinsurance Program – Pennsylvania
Status: Enacted Year Enacted: 2019
Provides the department and the exchange authority may promulgate regulations as may be necessary and appropriate to carry out the provisions of this part.
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40 Pa. Stat. and Cons. Stat. Ann. § 61. Jurisdiction over providers of health care benefits: The Insurance Department Act of 1921 – Pennsylvania
Status: Enacted Year Enacted: 1992
Any person or entity which provides medical benefits whether the benefits are provided by direct payment, reimbursement or otherwise, shall comply with the requirements of section 208, unless the person or other entity shows that …
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40 Pa. Stat. and Cons. Stat. Ann. § 756.2. Group accident and sickness insurance: Health and Accident Insurance – Pennsylvania
Status: Enacted Year Enacted: 1955
Governs the issuance of group accident and sickness insurance.
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