40 Pa. Stat. § 981-2

Current through Pa Acts 2024-53, 2024-56 through 2024-111

Section 981-2 - Definitions

(a) As used in this article, the following words and phrases shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Commissioner." The Insurance Commissioner of the Commonwealth.

"Department." The Insurance Department of the Commonwealth.

"Designated insurers." An insurer required to offer health coverage to eligible individuals under section 1003-A.

"Eligible individual." A resident of this Commonwealth who meets the definition in section 2741(b) of the Federal Health Insurance Portability and Accountability Act of 1996 ( Public Law 104-191, 110 Stat. 1936).

"Federal act." The Federal Health Insurance Portability and Accountability Act of 1996 ( Public Law 104-191, 110 Stat. 1936).

"Fraternal benefit society." An entity holding a current certificate of authority in this Commonwealth under the act of December 14, 1992 (P.L. 835, No. 134) , known as the "Fraternal Benefit Societies Code."

"Health maintenance organization" or "HMO." An entity holding a current certificate of authority under the act of December 29, 1972 (P.L. 1701, No. 364), known as the "Health Maintenance Organization Act."

"Hospital plan corporation." An entity holding a current certificate of authority organized and operated under 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations).

"Insurer." A foreign or domestic insurance company, association or exchange, health maintenance organization, hospital plan corporation, professional health services plan corporation, fraternal benefit society or risk-assuming preferred provider organization. The term does not include a group health plan as defined in section 2791 of the Federal Health Insurance Portability and Accountability Act of 1996 ( Public Law 104-191, 110 Stat. 1936).

"Medical loss ratio." The ratio of incurred medical claim costs to earned premiums.

"Preferred provider organization" or "PPO." An entity holding a current certificate of authority organized and operated under section 630 of this act.

"Professional health services plan corporation." An entity holding a current certificate of authority organized and operated under 40 Pa.C.S. Ch. 63 (relating to professional health services plan corporations). The term does not include dental service corporations or optometric service corporations as defined under 40 Pa.C.S. § 6302(a) (relating to definitions).

(b) The words, terms and definitions found in the Federal Health Insurance Portability and Accountability Act of 1996 ( Public Law 104-191, 110 Stat. 1936), including, but not limited to, those definitions in section 2791 of that act, are hereby adopted for purposes of implementing this article unless otherwise provided by this article. The term "health insurance issuer" found in section 2791(b)(2) of the Federal Health Insurance Portability and Accountability Act of 1996 ( Public Law 104-191, 110 Stat. 1936) shall have the same meaning as "insurer" in subsection (a).

40 P.S. § 981-2

1921, May 17, P.L. 682, No. 284, § 1002--A, added 1997, Nov. 4, P.L. 492, No. 51, § 4, effective 1/1/1998.