40 Pa. Stat. § 3801.502

Current through Pa Acts 2024-53, 2024-56 through 2024-92
Section 3801.502 - Definitions

Chapter 5 of the Accident and Health filing Reform Act [40 P.S. §§ 3801.501 to 3801.514] effective upon publication of notice under 40 P.S. § 3801.5103.

The following words and phrases when used in this chapter shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Commissioner." The Insurance Commissioner of the Commonwealth.

"Company," "association" or "exchange." An entity defined in section 101 of the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921.

"Department." The Insurance Department of the Commonwealth.

"Filing." A form or rate required by section 503 .

"Form." A policy, contract, certificate, evidence of coverage, application, rider or endorsement affording insurance coverage or benefit against loss from sickness or loss or damage from bodily injury or death of the insured by accident and each modification of any of the above.

"Fraternal benefits society." An entity organized and operating under Article XXIV of the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921.

"Group accident and health insurance." A form affording insurance coverage against death, injury, disablement, disease or sickness resulting from an accident and covering more than one person. The term shall not include blanket accident insurance policies as defined in section 621.3 of the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921.

"Health care provider." A person, corporation, facility, institution or other entity licensed, certified or approved by the Commonwealth to provide health care or professional medical services. The term includes, but is not limited to, physicians, professional nurses, certified nurse-midwives, podiatrists, hospitals, nursing homes, ambulatory surgical centers or birth centers.

"Health maintenance organization" or "HMO." An entity organized and operating under the act of December 29, 1972 (P.L. 1701, No. 364), known as the Health Maintenance Organization Act.

"Hospital plan corporation." An entity organized and operating under 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations).

"Insurer." A foreign or domestic company, association or exchange, hospital plan corporation, professional health services plan corporation, fraternal benefits society and risk-assuming preferred provider organization.

"Preferred provider organization." An entity organized and operating under section 630 of the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921.

"Professional health services plan corporation." An entity organized and operating under 40 Pa.C.S. Ch. 63 (relating to professional health services plan corporations).

"Provider contracts." An agreement made between an insurer and a health care provider regarding the provision of any payment for health care services. The term shall not include contracts or related documents which are subject to the exclusive approval of the Department of Health under 40 Pa.C.S. § 6324 (relating to rights of health service doctors) and section 630 of the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921.

"Rate." A manual of classification, rules and rates, each rating plan and each modification of any of the above.

"Statement of policy." A document as defined in 45 Pa.C.S. § 501 (relating to definitions), provided that the document has been published in the Pennsylvania Bulletin.

40 P.S. § 3801.502

1996, Dec. 18, P.L. 1066, No. 159, § 502, added 2011, Dec. 22, P.L. 615, No. 134, § 7.