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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 3392 (June 24, 2023).

31 Pa. Code § 154.1. Applicability and purpose.


§ 154.1. Applicability and purpose.

 (a)  This chapter governs quality health care accountability and protection and applies to managed care plans and licensed insurers subject to the act. The Department and the Department of Health both have regulatory authority under the act. This chapter does not apply to health care services and claims processed under automobile and worker’s compensation policies.

 (b)  The terms and conditions of group and individual contract renewals and new business written by managed care plans on or after January 1, 1999, shall conform to the act.

 (c)  An entity, including an IDS, subcontracting with a managed care plan to provide services to enrollees shall meet the requirements of the act and this chapter for services provided to those enrollees.

 (d)  Policies which partially insure an entity’s risk, shall meet the requirements of the act if they are issued by a managed care plan.

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