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PA Bulletin, Doc. No. 10-2081


Certification as an Independent Review Organization; Long-Term Care Benefit Trigger Determinations; Notice No. 2010-12

[40 Pa.B. 6370]
[Saturday, October 30, 2010]

 The act of July 9, 2010 (P. L. 362, No. 51) (Act 51) added to the Commonwealth's long-term care insurance laws a provision granting a right to appeal an insurer's determination that a benefit trigger is not met (fee section 1111a of the Insurance Company Act of 1921 (act)) (40 P. S. § 991.1111a). Act 51 also added definitions of ''benefit trigger'' and ''independent review organization'' to section 1103 of the act (40 P. S. § 991.1103).

 Under act 51, an entity must be certified by the Insurance Department (Department) to perform an independent review of benefit trigger determinations. To be certified, an independent review organization (IRO) must: (1) be certified as an IRO in another state, if the other state requires the IRO to meet substantially similar qualifications as those established by the National Association of Insurance Commissioners; or (2) be certified or approved by the Department. To maintain certification, the IRO shall comply with the requirements of the Act 51 amendments to the long-term care insurance laws and its representations in its application to the Commonwealth or any other state by which it is certified.

 The following organization has been approved by the Department to perform independent reviews of long-term care benefit trigger determinations: Clinix Healthcare, 3492 Snouffer Road, Suite 200, Columbus, OH 43235, (800) 854-8206, fax (614) 889-2148, contact: Olga Magyar.

 Questions regarding this notice may be directed to Carolyn M. Morris, Director, Bureau of Consumer Services at (717) 783-9862 or

Acting Commissioner

[Pa.B. Doc. No. 10-2081. Filed for public inspection October 29, 2010, 9:00 a.m.]

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