Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 52 Pa.B. 8372 (December 31, 2022).

31 Pa. Code § 152.17. Approval of enrollee literature after commencement of operations.

§ 152.17. Approval of enrollee literature after commencement of operations.

 (a)  Except for enrollee literature which has been reviewed and approved as part of its application for approval, no enrollee literature may be used by a preferred provider organization until the forms of the literature have been submitted to and formally approved by the Commissioner.

 (b)  Forms of enrollee literature will be deemed approved at the expiration of 60 days after filing, unless earlier approved or disapproved by the Commissioner. The approval becomes void upon subsequent notice of disapproval from the Commissioner.

 (c)  If the Commissioner determines that the literature does not adequately disclose the provisions, limitations and conditions of benefits available to enrollees, the Commissioner will notify the preferred provider organization, in writing, of the objections.

 (d)  Upon disapproval, the Commissioner will notify the preferred provider organization and the Secretary, in writing, specifying the reason for the disapproval. Within 30 days from the date of mailing of the notice to the preferred provider organization, the preferred provider organization may make written application to the Commissioner for a hearing. The hearing shall be held within 30 days after receipt of the application. The procedure before the Commissioner will be under the adjudication procedure in 2 Pa.C.S. § §  501—508 and 701—704 (relating to the Administrative Agency Law). The preferred provider organization is entitled to judicial review as provided by statute.

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