Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

28 Pa. Code § 9.676. Enrollee rights.

§ 9.676. Enrollee rights.

 (a)  A plan shall have a written policy that shall state the plan’s commitment to treating an enrollee in a manner that respects the enrollee’s rights and shall include the plan’s expectations of a member’s responsibilities.

 (b)  An HMO shall offer to each enrollee, who becomes ineligible to continue as a part of a group subscriber agreement, a nongroup subscription agreement offering the same level of benefits as are available to a group subscriber.

 (c)  An HMO may not expel or refuse to reenroll an enrollee solely because of the enrollee’s health care needs, nor refuse to enroll individual subscribers of a group on the basis of health status or health care needs of the individuals.

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