Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 6142 (September 30, 2023).

31 Pa. Code § 152.18. Policy review after commencement of operations.

§ 152.18. Policy review after commencement of operations.

 (a)  Except for policies which have been reviewed and approved as part of its application for approval, no policies, contracts or agreements between a risk-assuming preferred provider organization which is not a licensed insurer and its insureds may be used until the policies, contracts or agreements have been submitted to and formally approved by the Commissioner.

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

 (c)  Upon disapproval, the Commissioner will notify the preferred provider organization, 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 will 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.

Cross References

   This section cited in 31 Pa. Code §  153.3 (relating to simplified review of company merger, assumption or name change form and rate filings—statement of policy).

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