Deregulation of Accident and Health Forms

[27 Pa.B. 1893]

   The Insurance Commissioner hereby deregulates certain group policy forms for commercial products offered by Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), as authorized by Sections 3(A) and 3(B) of the Accident and Health Filing Reform Act, Act 159 of 1996 (Act 159), as set forth in Annex A.

Statutory Authority

   Section 3(A) of Act 159, the Accident and Health Filing Reform Act, requires that each insurer (including PPOs) and HMO file with the Pennsylvania Insurance Department (the Department) any policy form which it proposes to issue in the Commonwealth, except forms of a type or kind which, in the opinion of the Commissioner, do not require filing. Section 3(B) of Act 159 expressly authorizes and describes the method for the Commissioner to exempt forms from the filing process. Accordingly, the Commissioner hereby exempts from filing the forms for the lines of business listed in Annex A.

HMOs and Insurers Eligible for Exemption

   This deregulation applies only to the following entities that offer group insurance policies and products in the Commonwealth:

   *  Licensed HMOs organized and operating under the HMO Act, 40 P. S. §§ 1551 et seq.

   *  Licensed PPOs organized and operating under section 630 of the Act of May 17, 1921, P. L. 682, No. 284, as amended, known as the Insurance Company Law of 1921, 40 P. S. § 764a.

Forms Which are Not Deregulated

   The Commissioner's action extends to group policy forms used by HMOs and PPOs. The Commissioner has not deregulated policy forms used in the individual HMO and PPO markets. Thus, individual policies offered by HMOs and PPOs are not deregulated hereunder.

   Policy forms which are required to be submitted by an HMO or PPO during the application process to obtain a Certificate of Authority are not exempted from filing requirements by this notice.

   This deregulation shall not apply to any filing required by the Department of Health.

   This notice does not extend to group policy forms used by insurance companies, associations and exchanges, as defined by section 101 of the Insurance Company Law (40 P. S. § 361). Policy forms for those insurers were deregulated by separate notice. See 26 Pa.B. 1453 (March 30, 1996).

Continuing Authority of the Commissioner

   Notwithstanding the implementation of this proposal, the Commissioner will retain complete authority to request and be provided a copy of any form being issued in this Commonwealth, as provided by section 10 of Act 159.

   Under section 3(B) of Act 159, the Commissioner also will retain complete authority to reassume regulatory authority over the types of forms deregulated hereunder at her discretion. Notice of intent to resume regulatory authority shall be published in the Pennsylvania Bulletin.

   Notwithstanding the deregulation of the forms specified herein, all such forms must continue to comply with applicable Pennsylvania law including, but not limited to:

   Childhood Immunization Insurance, Act 35 of 1992 (40 P. S. §§ 3501 et seq)

   Coverage for Mammographic Examinations (40 P. S. § 764c)

   Women's Preventative Health Services Act (40 P. S. §§ 1571 et seq)

Effective Date

   This deregulation action is effective upon its publication in the Pennsylvania Bulletin.


   Questions concerning this notice may be directed to Gregory S. Martino, Deputy Insurance Commissioner, Office of Rate and Policy Regulation, 1311 Strawberry Square, Harrisburg, PA 17120, (717) 783-5079.

Annex A

Insurance Department

Deregulated HMO and PPO Forms

   The Insurance Commissioner, by this notice, hereby deregulates the following lines of business under the authority of Sections 3(A) and 3(B) of Act 159 of 1996, effective upon its publication in the Pennsylvania Bulletin.

   1)  Group HMO policy forms issued by HMOs under the Health Maintenance Organization Act, 40 P. S. §§ 1551 et seq. Regulations:  31 Pa. Code Chapter 301.

   2)  Group PPO policy forms issued under section 630 the Insurance Company Law of 1921, P. L. 682, No. 284, 40 P. S. § 764a. Regulations:  31 Pa. Code Chapter 152.

   3)  Riders, amendments and endorsements used with the above lines of business.

Insurance Commissioner

[Pa.B. Doc. No. 97-574. Filed for public inspection April 11, 1997, 9:00 a.m.]

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