40 Pa. Stat. § 1555.1

Current through P.A. Acts 2023-32
Section 1555.1 - Certificate of authority
(a) Every application for a certificate of authority under this act shall be made to the commissioner and secretary in writing and shall be in such form and contain such information as the regulations of the Departments of Insurance and Health may require.
(b) A certificate of authority shall be jointly issued by order of the commissioner and secretary when
(1) The secretary has found and determined that the applicant:
(i) Has demonstrated the potential ability to assure both availability and accessibility of adequate personnel and facilities in a manner enhancing availability, accessibility and continuity of services;
(ii) Has arrangements for an ongoing quality of health care assurance program; and
(iii) Has appropriate mechanisms whereby the health maintenance organization will effectively provide or arrange for the provision of basic health care services on a prepaid basis; and
(2) The commissioner has found and determined that the applicant has a reasonable plan to operate the health maintenance organization in a financially sound manner and is reasonably expected to meet its obligations to enrollees and prospective enrollees. In making this determination, the commissioner may consider:
(i) The adequacy of working capital and funding sources.
(ii) Arrangements for insuring the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage in the event of discontinuance of the health maintenance organization.
(iii) Any agreement with providers of health care services whereby they assume financial risk for the provision of services to subscribers.
(iv) Any deposit of cash, or guaranty or maintenance or minimum restricted reserves which the commissioner, by regulation, may adopt to assure that the obligations to subscribers will be performed.
(c) Within ninety days of receipt of a completed application for a certificate of authority, the commissioner and secretary shall jointly either:
(1) approve the application and issue a certificate of authority; or
(2) disapprove the application specifying in writing the reasons for such disapproval. Any disapproval of an application may be appealed in accordance with Title 2 of the Pennsylvania Consolidated Statutes (relating to administrative law and procedure).

40 P.S. § 1555.1

1972, Dec. 29, P.L. 1701, No. 364, § 5.1, added 1980, Dec. 19, P.L. 1300, No. 234, § 3, effective in 60 days.