40 Pa.C.S. § 6335 — PA Code / Title 40 / Chapter 63 / Section 6335
Ancillary health services.
Status: in_force

Anything in this chapter to the contrary notwithstanding, a professional health service corporation may provide ancillary health services through ancillary health service providers. An ancillary health service provider may register with a professional health service corporation as a participating provider and continue as such upon complying with such regulations as the corporation may make with the approval of the Department of Health. (Nov. 17, 1982, P.L.681, No.193, eff. 60 days) 1982 Amendment. Act 193 added section 6335.
40 Pa.C.S. § 9508 — PA Code / Title 40 / Chapter 95 / Section 9508
Annual audit.
Status: in_force

(a) Annual audit.--The reinsurance program shall be examined and audited annually by an independent certified public accounting firm. The audit shall, at a minimum:

(1) Assess compliance with the requirements of this chapter.

(2) Identify any material weaknesses or significant deficiencies and identify and implement solutions to correct the material weaknesses or deficiencies.

(b) Sharing of audit.--By December 31 of each year, the department shall electronically share the audit of the preceding fiscal year required under subsection (a) and related documents by:

(1) Posting the following on the department's publicly accessible Internet website:

(i) The audit.

(ii) A summary of the audit, including any material weakness or significant deficiency identified and how the department intends to correct the material weakness or significant deficiency.

(2) Providing an electronic link to the posted audit under paragraph (1)(i) to the Secretary of the Senate and the Chief Clerk of the House of Representatives.

(c) Payment.--The cost of the annual audit required under subsection (a) shall be paid for from money in the Reinsurance Fund. Cross References. Section 9508 is referred to in sections 9506, 9513 of this title.
40 Pa.C.S. § 9312 — PA Code / Title 40 / Chapter 93 / Section 9312
Exchange fund.
Status: in_force

(a) Establishment.--The Pennsylvania Health Insurance Exchange Fund is established as a special fund within the State Treasury. The exchange fund shall be administered by the exchange authority for the purposes set forth in this chapter, including the deposit of money that may be received pursuant to and disbursements permitted by this chapter.

(b) Deposit and use of money.--The following apply:

(1) Money deposited into the exchange fund shall be held for the purposes set forth in this chapter and may not be considered a part of the General Fund.

(2) Money in the exchange fund may only be used to effectuate the purposes of this chapter as determined by the exchange authority.

(3) All interest earned from the investment or deposit of money in the exchange fund shall be deposited into the exchange fund.

(4) All accrued and future earnings from money invested by the exchange authority and other accrued and future earnings from nonappropriated money, including, but not limited to, money obtained from the Federal Government and fees, shall be available to the exchange authority and shall be deposited into the State Treasury and may be utilized at the discretion of the board for carrying out any of the corporate purposes of the exchange authority.

(5) Placement of money by the State Treasurer in depositories or investments shall be consistent with guidelines approved by the board.

(6) For the purpose of administration, the exchange authority shall be subject to sections 610, 613 and 614 of act of April 9, 1929 (P.L.177, No.175), known as The Administrative Code of 1929.

(c) Nonlapsing and revolving fund.--The exchange fund shall be a nonlapsing fund. All money in the exchange fund and interest accrued are appropriated to the exchange authority for expenditure consistent with this chapter. Cross References. Section 9312 is referred to in sections 9103, 9305 of this title.
40 Pa.C.S. § 6323 — PA Code / Title 40 / Chapter 63 / Section 6323
Action as agent under Federal and other programs.
Status: in_force

(a) General rule.--Any professional health service corporation may, with the approval of the department, act as a contracting agency or organization under section 1842 of Title XVIII of the Federal Social Security Act, as amended or supplemented, with power to perform all the services which may be required of a contracting agency or organization thereunder and may perform administrative services similar or related to those which may be required of an agency or organization thereunder in connection with a Federal, State or local governmental health care program and may perform administrative services similar or related to those which may be required of such an agency or organization in connection with or associated with nongovernmental organizations, individuals, groups and agencies in the health care field.

(b) Legislative amendment of stated purposes of existing corporations.--The stated purposes of all existing professional health service corporations are hereby amended so as to include the performance of the activities authorized by subsection (a) of this section.
40 Pa.C.S. § 9505 — PA Code / Title 40 / Chapter 95 / Section 9505
Insurer eligibility and duties.
Status: in_force

(a) Eligibility for payment.--An insurer shall be eligible for a reinsurance payment if:

(1) The claims costs for a reinsurance-eligible enrollee's covered benefits in a benefit year exceed the attachment point.

(2) The eligible insurer has implemented and documented reasonable care management practices for enrollees who are the subject of reinsurance claims through the reinsurance program.

(3) The eligible insurer makes its requests for reinsurance payments in accordance with any requirements established by the department, including requirements related to the format, structure and timing for submission of claims for reinsurance payments.

(4) The eligible insurer participated in the exchange, or is affiliated with an entity that participated in the exchange, in the benefit year in which the claims costs for which a reinsurance payment is sought were incurred.

(b) Reporting requirement.--An insurer that seeks reinsurance payments under this chapter must report to the department, in the form and manner prescribed by the department, information about reinsurance-eligible enrollees insured by the insurer as necessary for the department to calculate reinsurance payments.

(c) Confidentiality.--Reinsurance claims submitted under this section are confidential and are not subject to public disclosure, except as provided under section 9514 (relating to immunity).

(d) Consideration for rate filings.--In a rate filing for a health insurance policy to be offered through the exchange, the impact of reinsurance payments under this chapter shall be identified.

(e) Limitation.--The calculation of reinsurance payments due to an eligible insurer shall be net of all other available insurance payments applicable to a claim, including insurance accessible through subrogation or coordination of benefits.
40 Pa.C.S. § 4704 — PA Code / Title 40 / Chapter 47 / Section 4704
Right to examine and return pet insurance policy.
Status: in_force

(a) General rule.--Except as provided in subsection (b), an individual who applies for a pet insurance policy may examine the pet insurance policy and, if not satisfied with the pet insurance policy for any reason, may return the pet insurance policy to the company that produced the pet insurance policy, or an agent or insurance producer of the company, within 30 days of receipt of the pet insurance policy. The following apply:

(1) The company that produced the pet insurance policy shall refund any premium paid by the individual regarding the pet insurance policy within 30 days after receiving the returned pet insurance policy.

(2) A refunded premium shall be sent directly to the person who paid the premium.

(3) If a pet insurance policy is returned in accordance with this subsection, the pet insurance policy shall be void as if it had never been issued.

(b) Exception.--Subsection (a) shall not apply if the individual is an insured who has filed a claim under the pet insurance policy.

(c) Notice.--Each pet insurance policy shall have the following notice printed in at least 12-point type, which shall be included on the first page of the pet insurance policy or attached to the pet insurance policy: You have 30 days from the day you receive this policy, certificate or rider to review it and return it to the company if you decide not to keep it. You do not have to tell the company why you are returning it. If you decide not to keep it, simply return it to the company at its administrative office or you may return it to the agent or insurance producer that you bought it from as long as you have not filed a claim. You must return it within 30 days of the day you first received it. The company will refund the full amount of any premium paid within 30 days after it receives the returned policy, certificate or rider. The premium refund will be sent directly to the person who paid it. The policy, certificate or rider will be void as if it had never been issued. Cross References. Section 4704 is referred to in section 4705 of this title.
40 Pa.C.S. § 6321 — PA Code / Title 40 / Chapter 63 / Section 6321
Required reserves.
Status: in_force

A professional health service corporation shall at all times while engaged in business maintain reserves, in such form and amount as the department may determine, to insure its subscribers against loss through the failure of the corporation to provide the services agreed to in its contracts.
40 Pa.C.S. § 9302 — PA Code / Title 40 / Chapter 93 / Section 9302
Pennsylvania Health Insurance Exchange Authority.
Status: in_force

(a) Establishment.--The Pennsylvania Health Insurance Exchange Authority is established as a State-affiliated entity. The powers and duties of the exchange authority shall be vested in and exercised by a board, which shall have the sole power under section 9305 (relating to powers and duties of exchange authority) to employ staff, including an executive director. Individuals employed by the exchange authority shall be employees of the Commonwealth. The exchange authority may contract with persons or entities, including legal counsel, consultants or service providers, as deemed necessary in the exchange authority's discretion.

(b) Purpose.--The purpose of the exchange authority shall be to create, manage and maintain in this Commonwealth the Pennsylvania Health Insurance Exchange to do all of the following:

(1) Benefit the Pennsylvania health insurance market and persons enrolling in health insurance policies.

(2) Facilitate or assist in facilitating the purchase of on-exchange qualified plans by qualified enrollees in the individual market or the individual and small group markets.

(c) Composition.--The board shall consist of the following members:

(1) Three voting members who shall be the following heads of agencies or a designee who shall be an employee of the agency designated in writing by the head of the agency prior to service:

(i) The commissioner, ex-officio.

(ii) The Secretary of Human Services, ex-officio.

(iii) The Secretary of Health, ex-officio.

(2) Four voting members appointed by the Governor:

(i) One member from among the insurers that offer health insurance policies through the exchange that are a hospital plan corporation, a professional health services plan corporation or a parent, affiliate, subsidiary or other associated entity or successor of a hospital plan corporation or a professional health services plan.

(ii) One member from among the insurers that offer health insurance policies through the exchange that are not a hospital plan corporation, a professional health services plan corporation or a parent, affiliate, subsidiary or other associated entity or successor of a hospital plan corporation or a professional health services plan.

(iii) One member with experience in health care public education and consumer assistance activities who does not have a conflict of interest as described in subsection (k).

(iv) One member who is a consumer representative.

(3) Four voting members appointed by the General Assembly as follows:

(i) One individual appointed by the President pro tempore of the Senate.

(ii) One individual appointed by the Minority Leader of the Senate.

(iii) One individual appointed by the Speaker of the House of Representatives.

(iv) One individual appointed by the Minority Leader of the House of Representatives.

(4) The executive director shall attend meetings of the board but shall not be a member, may not vote and may not be counted for purposes of establishing a quorum.

(d) Chairperson.--The commissioner or a designee shall serve as chairperson.

(e) Compensation.--Board members shall not be entitled to any compensation for their services as members, except that, subject to the availability of funds, board members shall be entitled to reimbursement for actual and necessary travel expenses. The expenses shall be paid for by the exchange fund.

(f) Terms.--The terms of the board members shall be as follows:

(1) A board member appointed under subsection (c)(3) who:

(i) Is a member of the General Assembly shall serve a term concurrent with their holding of public office.

(ii) Is not a member of the General Assembly shall serve a term concurrent with their appointing official's holding of public office.

(2) A board member appointed under subsection (c)(2) shall serve a term of four years, not to exceed more than two full consecutive four-year terms, except that the following shall apply:

(i) Initial appointments shall be so staggered that less than 50% of the membership shall expire each year.

(ii) A member's term shall continue until the member's replacement is appointed.

(g) Vacancies.--Vacancies in appointed positions shall be filled in the same manner as the original appointment. Members shall serve until their successors are appointed and qualified.

(h) Formation.--The exchange authority shall be formed within 60 days of the effective date of this section. Prior to formation of the exchange authority, the commissioner may take action necessary to effect a timely transition from a federally administered exchange to the Pennsylvania Health Insurance Exchange.

(i) Quorum.--A majority of the appointed members of the board shall constitute a quorum. Action may be taken by the board at a meeting upon a vote of a quorum of its members present in person or through electronic means. If a tie vote occurs at any meeting, it shall be the duty of the chairperson of the board to cast a second and deciding vote.

(j) Meetings.--The board shall meet at the call of the chairperson or as may be provided in the bylaws of the board. The board shall hold meetings at least quarterly, which shall be subject to the requirements of 65 Pa.C.S. Ch. 7 (relating to open meetings).

(k) Experience and interests.--For purposes of this chapter, the board shall assure that it complies with section 1321 of the Affordable Care Act (Public Law 111-148, 42 U.S.C. § 18041) and regulations promulgated under the Affordable Care Act regarding conflicts of interest and relevant experience.

(l) Conflict of interest.--The following apply:

(1) Except as provided under paragraph (2), a non-State employee board member shall not be subject to 65 Pa.C.S. Ch. 11 (relating to ethics standards and financial disclosure), including the requirements for filing statements of financial interests.

(2) A non-State employee board member may not engage in conduct that, if that member were a State employee, would constitute a conflict of interest under 65 Pa.C.S. Ch. 11.

(3) A majority of the voting members of the board may not have a conflict of interest as set forth in section 1321 of the Affordable Care Act and regulations promulgated under the Affordable Care Act. Cross References. Section 9302 is referred to in section 9103 of this title.
40 Pa.C.S. § 7103 — PA Code / Title 40 / Chapter 71 / Section 7103
Special applicability provisions.
Status: in_force

The standards for the valuation of reserve liabilities for life insurance, accident and health insurance and deposit-type contracts shall be subject to the following applicability provisions:

(1) The following shall apply to policies or contracts subject to this chapter that were issued on or after May 17, 1921, and prior to the operative date of the valuation manual:

(i) Section 7115 (relating to computation of minimum standard).

(ii) Section 7116 (relating to computation of minimum standard for annuities).

(iii) Section 7117 (relating to computation of minimum standard by calendar year of issue).

(iv) Section 7118 (relating to reserve valuation method for life insurance and endowment benefits).

(v) Section 7119 (relating to reserve valuation method for annuity and pure endowment benefits).

(vi) Section 7120 (relating to minimum reserves).

(vii) Section 7121 (relating to optional reserve calculation).

(viii) Section 7122 (relating to reserve calculation for valuation net premium exceeding gross premium charged).

(ix) Section 7123 (relating to reserve calculation for indeterminate premium plans).

(2) Except as otherwise provided in this chapter, section 7124 (relating to minimum standard for accident and health insurance contracts) shall apply to policies issued before, on or after the operative date of the valuation manual.

(3) The following shall not apply to policies or contracts subject to this chapter that were issued on or after May 17, 1921, and prior to the operative date of the valuation manual:

(i) Section 7125 (relating to valuation manual for policies issued on or after operative date of valuation manual).

(ii) Section 7126 (relating to requirements of principle-based valuation).

(4) Sections 7125 and 7126 shall apply to policies issued on or after the operative date of the valuation manual.
40 Pa.C.S. § 7102 — PA Code / Title 40 / Chapter 71 / Section 7102
Definitions.
Status: in_force

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:

"Accident and health insurance." A contract that incorporates morbidity risk and provides protection against economic loss resulting from accident, sickness or medical conditions and as may be specified in the valuation manual.

"Appointed actuary." A qualified actuary who is appointed in accordance with the valuation manual to prepare the actuarial opinion required by section 7114 (relating to actuarial opinion of reserves on or after operative date of valuation manual).

"Commissioner." The Insurance Commissioner of the Commonwealth.

"Company." An entity, including a fraternal benefit society, that:

(1) has written, issued or reinsured life insurance contracts, accident and health insurance contracts or deposit-type contracts in this Commonwealth and has at least one policy in force or on claim; or

(2) is required to hold a certificate of authority to write life insurance contracts, accident and health insurance contracts or deposit-type contracts in this Commonwealth.

"Department." The Insurance Department of the Commonwealth.

"Deposit-type contract." A contract that does not incorporate mortality or morbidity risks and as may be specified in the valuation manual.

"Experience data." Documents, materials, data and other information submitted by a company under section 7127 (relating to experience reporting for policies in force on or after operative date of valuation manual).

"Experience materials." Documents, materials, data and other information, including all working papers and copies of all these items created or produced in connection with experience data, which include any potentially company-identifying or personally identifiable information provided to or obtained by the commissioner.

"Fraternal benefit society." As provided for under Article XXIV of The Insurance Company Law of 1921.

"Group-wide supervisor." The chief insurance regulatory official who is:

(1) Authorized to engage in conducting and coordinating group-wide supervision activities.

(2) From the jurisdiction determined or acknowledged by the department under section 1406.2(c) of The Insurance Company Law of 1921 to have sufficient, significant contacts with the international insurance group.

"IAIS." The International Association of Insurance Supervisors or its successor organization.

"Life insurance." A contract that incorporates mortality risk, including an annuity or pure endowment contract, and as may be specified in the valuation manual.

"NAIC." The National Association of Insurance Commissioners, its subsidiaries or affiliates or its successor organization.

"Operative date of the valuation manual." The January 1 of the first calendar year following the first July 1 when all of the following have occurred:

(1) The valuation manual has been adopted by NAIC by an affirmative vote of at least 42 members or 75% of the members voting, whichever is greater.

(2) The Standard Valuation Law, as amended by NAIC in 2009, or legislation including substantially similar terms and provisions, has been enacted by both of the following:

(i) States representing more than 75% of the direct premiums written as reported for life, accident and health annual statements, health annual statements or fraternal annual statements submitted in 2008.

(ii) At least 42 of the 55 NAIC member jurisdictions, including the 50 states, American Samoa, the United States Virgin Islands, the District of Columbia, Guam and the Commonwealth of Puerto Rico.

"Policyholder behavior." An action taken by a policyholder, certificate holder, contract holder or any other person having the right to elect options as to a policy or contract subject to this chapter. The options shall:

(1) Include lapse, withdrawal, transfer, deposit, premium payment, loan, annuitization or benefit elections prescribed by the policy or contract.

(2) Exclude events of mortality or morbidity that result in benefits prescribed in their essential aspects by the terms of the policy or contract.

"Principle-based valuation." A reserve valuation that:

(1) Uses one or more methods or one or more assumptions determined by the insurer.

(2) Is required to comply with section 7126 (relating to requirements of principle-based valuation) as specified in the valuation manual.

"Qualified actuary." An individual who:

(1) Is qualified to sign the applicable statement of actuarial opinion in accordance with the American Academy of Actuaries qualification standards for actuaries signing these statements of actuarial opinion.

(2) Meets the requirements specified in the valuation manual. "Reserve liabilities," "reserves" or "net value." An amount recorded in financial statements to reflect potential obligations.

"Tail risk." A risk that occurs where:

(1) the frequency of low probability events is higher than expected under a normal probability distribution; or

(2) there are observed events of very significant size or magnitude.

"The Insurance Company Law of 1921." The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921.

"Valuation manual." The manual of valuation instructions adopted by NAIC or as subsequently amended and adopted by NAIC. Unless a change in the valuation manual specifies a later effective date, a change to the valuation manual is effective on January 1 following the date when the change to the valuation manual has been adopted by NAIC by an affirmative vote representing both of the following:

(1) At least 75% of the members of NAIC voting, but not less than a majority of the total membership.

(2) Members of NAIC representing jurisdictions totaling more than 75% of the direct premiums written as reported in the most recently available life, accident and health annual statements, health annual statements or fraternal annual statements. Cross References. Section 7102 is referred to in section 7104 of this title.
40 Pa.C.S. § 9311 — PA Code / Title 40 / Chapter 93 / Section 9311
Reports.
Status: in_force

(a) Report.--The exchange authority shall prepare an annual report on the activities of the exchange authority for the year and:

(1) Electronically transmit the report to:

(i) The Governor.

(ii) The President pro tempore of the Senate.

(iii) The Minority Leader of the Senate.

(iv) The Speaker of the House of Representatives.

(v) The Minority Leader of the House of Representatives.

(vi) The chair and minority chair of:

(A) The Appropriations Committee of the Senate.

(B) The Appropriations Committee of the House of Representatives.

(C) The Banking and Insurance Committee of the Senate.

(D) The Insurance Committee of the House of Representatives.

(E) The Health and Human Services Committee of the Senate.

(F) The Health Committee of the House of Representatives.

(2) Post the report on the exchange authority's publicly accessible Internet website.

(b) Federal compliance.--The exchange authority shall comply with applicable Federal reporting requirements.

(c) Department notification.--The exchange authority shall provide a copy of or electronic link to the report provided under subsection (a) or (b) to the department. Cross References. Section 9311 is referred to in section 9307 of this title.
40 Pa.C.S. § 5010 — PA Code / Title 40 / Chapter 50 / Section 5010
Delivery of insurance policies and endorsements.
Status: in_force

(a) Authorization.--An insurer may mail, deliver or, if the plan sponsor obtains a separate specific consent, post on the insurer's publicly accessible Internet website an insurance policy and endorsement that does not contain any personally identifiable information.

(b) Internet website posting requirements.--If an insurer elects to post an insurance policy and endorsement on the insurer's publicly accessible Internet website, in lieu of mailing or delivering the policy and endorsement to the insured, the insurer shall have the following duties:

(1) The insurer shall ensure that the policy and endorsement are accessible to the plan sponsor and producer of record and remains accessible while the policy is in effect.

(2) After the expiration of the policy, the insurer shall do one of the following:

(i) Make the expired policy and endorsement available upon request for a period of no less than five years.

(ii) If the insurer continues to make the expired policy or endorsement available on the insurer's publicly accessible Internet website, keep the plan sponsor's user identification active for a period of not less than five years.

(c) Printable format.--If an insurer elects to post an insurance policy and endorsement on the insurer's publicly accessible Internet website in lieu of mailing or delivering the policy and endorsement to the covered person, the insurer shall post the policy and endorsement in a manner that enables the plan sponsor and producer of record to print and save the policy and endorsement using a program or application that is widely available on the Internet and free to use.

(d) Description.--The insurer shall provide the following information to the plan sponsor in or simultaneous with each declaration page provided at the time of issuance of an initial insurance policy and each renewal of the policy:

(1) A description of the exact policy and endorsement form purchased by the plan sponsor.

(2) A description of the plan sponsor's right to receive upon request and without charge an electronic or paper copy of the policy and endorsement.

(3) The publicly accessible Internet website at which the policy and endorsement are posted by the insurer.

(e) Paper copies.--Upon request by the plan sponsor, the insurer shall mail a paper copy of the plan sponsor's insurance policy and endorsement. The insurer shall mail the first paper copy of the insurance policy and endorsement to the plan sponsor without charge, but may impose a fee on each subsequent request for a paper copy.
40 Pa.C.S. § 6310 — PA Code / Title 40 / Chapter 63 / Section 6310
Enforcement.
Status: in_force

When necessary to effect the purposes of this chapter, in addition to all other remedies in law or equity, the Insurance Department or the Department of Health, or both, may commence an action in mandamus or for an injunction to prevent any violation of the provisions of this chapter or the continuance of any such violation, or to enforce compliance herewith. Any court having jurisdiction is hereby vested with authority to determine the cause and to issue such process as may be necessary to accomplish the purposes of this chapter.
40 Pa.C.S. § 4518 — PA Code / Title 40 / Chapter 45 / Section 4518
Notification of cybersecurity event.
Status: in_force

(a) Notification to commissioner.--A licensee shall notify the commissioner as promptly as possible, but in no event later than five business days from a determination, that a cybersecurity event involving nonpublic information that is in the possession of the licensee has occurred when either of the following criteria have been met:

(1) The cybersecurity event has a reasonable likelihood of materially harming a consumer residing in this Commonwealth or any material part of the normal operations of the licensee and either:

(i) in the case of an insurer, this Commonwealth is the insurer's state of domicile; or

(ii) in the case of an insurance producer, as defined in section 601-A of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of 1921, this Commonwealth is the insurance producer's home state.

(2) The licensee reasonably believes that the nonpublic information involves 250 or more consumers residing in this Commonwealth and the cybersecurity event:

(i) impacts the licensee of which notice is required to be provided to a governmental body, self-regulatory agency or another supervisory body under any Federal or State law; or

(ii) has a reasonable likelihood of materially harming a consumer residing in this Commonwealth or any material part of the normal operations of the licensee.

(b) Content of notification.--As part of the notification under this section, a licensee shall provide as much of the following information as possible in electronic form:

(1) The date of the cybersecurity event.

(2) A description of how the information was exposed, lost, stolen or breached, including the specific roles and responsibilities of third-party service providers, if any.

(3) How the cybersecurity event was discovered.

(4) Whether any lost, stolen or breached information has been recovered and, if so, how this was done.

(5) The identity of the source of the cybersecurity event.

(6) Whether the licensee has filed a police report or has notified any regulatory, governmental or law enforcement agency and, if so, when the notification was provided.

(7) A description of the specific types of information acquired without authorization, including particular data elements such as the types of medical information, financial information or other types of information allowing identification of the consumer.

(8) The period during which the information systems were compromised by the cybersecurity event.

(9) The number of total consumers in this Commonwealth affected by the cybersecurity event. The licensee shall provide the best estimate in the initial report to the commissioner and update this estimate with each subsequent report to the commissioner under this section.

(10) The results of any internal review identifying a lapse in either automated controls or internal procedures or confirming that all automated controls or internal procedures were followed.

(11) A description of efforts being undertaken to remediate the situation that permitted the cybersecurity event to occur.

(12) A copy of the licensee's privacy policy and a statement outlining the steps that the licensee will take to investigate and notify consumers affected by the cybersecurity event.

(13) The name of a contact person familiar with the cybersecurity event and authorized to act for the licensee.

(c) Continuing obligation.--A licensee shall have a continuing obligation to update and supplement initial and subsequent notifications to the commissioner regarding material changes to previously provided information relating to a cybersecurity event.

(d) Other notices required.--A licensee shall comply with section 3 of the act of December 22, 2005 (P.L.474, No.94), known as the Breach of Personal Information Notification Act, as applicable, and provide a copy of the notice sent to consumers under the Breach of Personal Information Notification Act to the commissioner, whenever the licensee is required to notify the commissioner under subsection (a).

(e) Notice regarding cybersecurity events of third-party service providers.--

(1) In the case of a cybersecurity event in a system maintained by a third-party service provider of which the licensee has become aware, the licensee shall treat the event as it would under subsection (a) unless the third-party service provider provides the notice required under subsection (a) directly to the commissioner.

(2) The computation of a licensee's deadlines under this section shall begin on the day after the third-party service provider notifies the licensee of the cybersecurity event or the licensee otherwise has actual knowledge of the cybersecurity event, whichever is sooner.

(f) Notice regarding cybersecurity events of reinsurers to insurers.--

(1) In the case of a cybersecurity event involving nonpublic information that is used by a licensee, which is acting as an assuming insurer, or that is in the possession, custody or control of a licensee, which is acting as an assuming insurer and which does not have a direct contractual relationship with the affected consumers, the assuming insurer shall notify its affected ceding insurers and the commissioner of its state of domicile within three business days of making the determination that a cybersecurity event has occurred. The ceding insurers that have a direct contractual relationship with the affected consumers shall fulfill the consumer notification requirements imposed under section 3 of the Breach of Personal Information Notification Act and any other notification requirements relating to a cybersecurity event imposed under this section.

(2) In the case of a cybersecurity event involving nonpublic information that is in the possession, custody or control of a third-party service provider of a licensee that is an assuming insurer, the assuming insurer shall notify its affected ceding insurers and the commissioner of its state of domicile within three business days of receiving notice from its third-party service provider that a cybersecurity event has occurred. The ceding insurers that have a direct contractual relationship with the affected consumers shall fulfill the consumer notification requirements imposed under section 3 of the Breach of

Personal Information Notification Act and any other notification requirements relating to a cybersecurity event imposed under this section.

(3) A licensee acting as an assuming insurer shall have no other notice obligations relating to a cybersecurity event or other data breach under this section or any other law of this Commonwealth.

(g) Notice regarding cybersecurity events of insurers to producers of record.--In the case of a cybersecurity event involving nonpublic information in the possession, custody or control of a licensee that is an insurer or its third-party service provider for which a consumer accessed the insurer's services through an insurance producer, and for which consumer notice is required under section 3 of the Breach of Personal Information Notification Act, the insurer shall notify the producers of record of all affected consumers of the cybersecurity event no later than the time at which notice is provided to the affected consumers. The insurer shall be excused from this obligation in those instances in which the insurer does not have the current producer of record information for an individual consumer. Cross References. Section 4518 is referred to in sections 4532, 4535 of this title.
40 Pa.C.S. § 6333 — PA Code / Title 40 / Chapter 63 / Section 6333
Dental service agents.
Status: in_force

Any dental service corporation may select any person to act as its agent in the performance of any of its functions.
40 Pa.C.S. § 4001 — PA Code / Title 40 / Chapter 40 / Section 4001
Definitions.
Status: in_force

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:

"Health insurance policy." An individual or group policy, subscriber contract, certificate or plan issued by an insurer that provides medical or health care coverage. The term does not include any of the following:

(1) An accident only policy.

(2) A credit only policy.

(3) A long-term care or disability income policy.

(4) A specified disease policy.

(5) A Medicare supplement policy.

(6) A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy.

(7) A fixed indemnity policy.

(8) A dental only policy.

(9) A vision only policy.

(10) A workers' compensation policy.

(11) An automobile medical payment policy.

(12) Another similar policy providing for limited benefits.

"Insurer." An entity licensed by the department with accident and health authority to issue a health insurance policy that is offered or governed under any of the following:

(1) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV of that act.

(2) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act.

(3)
40 Pa.C.S. § 6301 — PA Code / Title 40 / Chapter 63 / Section 6301
Application of chapter.
Status: in_force

(a) General rule.--This chapter shall apply to every person engaged in the business of maintaining and operating a nonprofit health service plan and to every person who shall violate any provision of this chapter.

(b) Exceptions.--Notwithstanding subsection (a) of this section, this chapter shall not apply to:

(1) Any hospital plan corporations as defined in section 6101 of this title (relating to hospital plan corporation definitions).

(2) Any fraternal benefit society subject to regulation under Chapter 65 of this title (relating to fraternal benefit societies). References in Text.
40 Pa.C.S. § 7126 — PA Code / Title 40 / Chapter 71 / Section 7126
Requirements of principle-based valuation.
Status: in_force

(a) Characteristics of valuation.--For policies or contracts specified in the valuation manual, a company shall establish reserves using a principle-based valuation that:

(1) Quantifies benefits and guarantees and the funding associated with contracts and their risks at a level of conservatism that reflects conditions that include unfavorable events having a reasonable probability of occurring during the lifetime of the contracts. For policies or contracts with significant tail risk, the valuation must reflect conditions appropriately adverse to quantify the tail risk.

(2) Incorporates assumptions, risk analysis methods and financial models and management techniques that are consistent with, but not necessarily identical to, those utilized within the company's overall risk assessment process, while recognizing potential differences in financial reporting structures and any prescribed assumptions or methods.

(3) Incorporates assumptions that are:

(i) Prescribed in the valuation manual.

(ii) If not prescribed in the valuation manual, established by utilizing either of the following:

(A) The company's available experience, to the extent it is relevant and statistically credible.

(B) Other relevant and statistically credible experience, to the extent that company data is not available, relevant or statistically credible.

(4) Provides margins for uncertainty, including adverse deviation and estimation error, so that the greater the uncertainty, the larger the margin and resulting reserve.

(b) Company requirements.--A company using a principle-based valuation for one or more policies or contracts subject to this section as specified in the valuation manual shall:

(1) Establish procedures for corporate governance and oversight of the actuarial valuation function consistent with those described in the valuation manual.

(2) Provide to the commissioner and the board of directors an annual certification of the effectiveness of the internal controls with respect to the principle-based valuation. These controls shall be designed to assure that all material risks inherent in the liabilities and associated assets subject to this valuation are included in the valuation and that valuations are made in accordance with the valuation manual. The certification shall be based on the controls in place as of the end of the preceding calendar year.

(3) Develop and file with the commissioner upon request a principle-based valuation report that complies with standards prescribed in the valuation manual.

(c) Formulaic reserve component.--A principle-based valuation may include a prescribed formulaic reserve component. Cross References. Section 7126 is referred to in sections 7102, 7103, 7112, 7125, 7131, 7137, 7141 of this title.
40 Pa.C.S. § 5102 — PA Code / Title 40 / Chapter 51 / Section 5102
Rebates and inducements.
Status: in_force

(a) Unfair or deceptive acts or practices.--Except as otherwise expressly provided by law, each of the following is deemed to be an unfair or deceptive act or practice in the business of insurance:

(1) Knowingly permitting, offering to make or making an insurance policy, or an agreement as to the insurance policy, other than as plainly expressed in the insurance policy that is issued.

(2) Paying, allowing or giving, or offering to pay, allow or give, directly or indirectly, as inducement to an insurance policy, any of the following not specified in the insurance policy:

(i) A rebate of premiums payable on the insurance policy.

(ii) A special favor or advantage in the dividends or other benefits on the insurance policy.

(iii) Valuable consideration or inducement.

(3) Giving, selling or purchasing, or offering to give, sell or purchase, as inducement to an insurance policy, any of the following not specified in the insurance policy:

(i) Stocks, bonds or other securities of a company or other corporation, association or partnership.

(ii) Any dividends or profits accrued on the items described in subparagraph (i).

(iii) Anything of value whatsoever.

(b) Construction.--Nothing in subsection (a) shall be construed as including within the definition of discrimination or rebates any of the following practices:

(1) In the case of an insurance policy involving life insurance or an annuity, paying bonuses to policyholders or otherwise abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance, if the bonuses or abatement of premiums are fair and equitable to policyholders and for the best interests of the company and its policyholders.

(2) In the case of a life insurance policy issued on the industrial debit plan, making allowance to policyholders who have continuously for a specified period made premium payments directly to an office of the insurer in an amount that fairly represents the saving in collection expenses.

(3) Readjusting the rate of premium for a group insurance policy based on the loss or expense under the group insurance policy, at the end of the first or any subsequent policy year of insurance under the group insurance policy, which may be made retroactive only for that policy year.

(4) Engaging in an arrangement that would not violate:

(i) 12 U.S.C. § 1972 (relating to certain tying arrangements prohibited; correspondent accounts), as interpreted by the Board of Governors of the Federal Reserve System; or

(ii) 12 U.S.C. § 1464(q) (relating to Federal savings associations).

(5) Offering or providing, by an insurer or insurance producer, by or through employees, affiliates or third-party representatives, a value-added product or service at no or

reduced cost if the product or service is not specified in the insurance policy and if all of the following requirements are met:

(i) The product or service relates to the insurance coverage.

(ii) The product or service is primarily designed to satisfy one or more of the following:

(A) Provide loss mitigation or loss control.

(B) Reduce claim costs or claim settlement costs.

(C) Provide education about liability risks or risk of loss to persons or property.

(D) Monitor or assess risk, identify sources of risk or develop strategies for eliminating or reducing risk.

(E) Enhance health.

(F) Enhance financial wellness through items such as education or financial planning services.

(G) Provide post-loss services.

(H) Incentivize behavioral changes to improve the health or reduce the risk of death or disability of a customer.

(I) Assist in the administration of the employee or retiree benefit insurance coverage.

(iii) The cost to the insurer or insurance producer offering the product or service to a customer is reasonable in comparison to that customer's premiums or insurance coverage for the policy class.

(iv) If the insurer or insurance producer is providing the product or service, the insurer or insurance producer has ensured that the customer is provided with contact information to assist the customer with questions regarding the product or service.

(v) The availability of the product or service is based on documented objective criteria and offered in a manner that is not unfairly discriminatory. The insurer or insurance producer shall maintain the criteria and produce the criteria upon request by the department.

(c) Permissible activities.--An insurer or insurance producer may:

(1) Offer or give noncash gifts, items or services, including meals to or charitable donations on behalf of a customer, in connection with the marketing, sale, purchase or retention of insurance policies, in an amount not exceeding $125 on an annual, aggregate basis. The following apply:

(i) The commissioner may increase the amount by transmitting notice of the increase to the Legislative Reference Bureau for publication in the next available issue of the Pennsylvania Bulletin. The increase shall become effective upon publication of the notice in the Pennsylvania Bulletin.

(ii) The offer or gift shall be made in a manner that is not unfairly discriminatory and may not be contingent on the purchase or retention of insurance.

(2) Offer or give noncash gifts, items or services, including meals to or charitable donations on behalf of a customer, to commercial or institutional customers in connection with the marketing, sale, purchase or retention of insurance policies, if the cost is reasonable in comparison to the premium or proposed premium and the cost of the gift or service is not included in any amounts charged

to another person or entity. The offer or gift shall be made in a manner that is not unfairly discriminatory and may not be contingent on the purchase or retention of insurance.

(3) As follows:

(i) Conduct a raffle or drawing to the extent permitted by State law, if:

(A) there is no financial cost for entrants to participate;

(B) the raffle or drawing does not obligate participants to purchase insurance;

(C) the prizes are not valued in excess of $125; and

(D) the raffle or drawing is open to the public.

(ii) The commissioner may increase the amount under subparagraph (i)(C) by transmitting notice of the increase to the Legislative Reference Bureau for publication in the next available issue of the Pennsylvania Bulletin. The increase shall become effective upon publication of the notice in the Pennsylvania Bulletin.

(iii) The raffle or drawing shall be offered in a manner that is not unfairly discriminatory and may not be contingent on the purchase or retention of insurance. Cross References. Section 5102 is referred to in section 5104 of this title.
40 Pa.C.S. § 7115 — PA Code / Title 40 / Chapter 71 / Section 7115
Computation of minimum standard.
Status: in_force

(a) Applicability.--This section shall govern the minimum standard for the valuation of a company's policies and contracts except as provided in the following sections:

(1) Section 7116 (relating to computation of minimum standard for annuities).

(2) Section 7117 (relating to computation of minimum standard by calendar year of issue).

(3) Section 7124 (relating to minimum standard for accident and health insurance contracts).

(b) Policies and contracts issued prior to May 17, 1921.--The minimum standard for the valuation of policies and contracts issued prior to May 17, 1921, shall be as provided by the laws in effect immediately prior to May 17, 1921.

(c) Policies and contracts issued on or after May 17, 1921.--The minimum standard for the valuation of policies and contracts issued on or after May 17, 1921, shall be, together with the tables referenced under subsection (d), the commissioners reserve valuation methods established under sections 7118 (relating to reserve valuation method for life insurance and endowment benefits), 7119 (relating to reserve valuation method for annuity and pure endowment benefits), 7122 (relating to reserve calculation for valuation net premium exceeding gross premium charged) and 7124:

(1) Three and one-half percent interest.

(2) Four percent interest for life insurance policies and contracts, other than annuity and pure endowment contracts, issued on or after June 23, 1976, and prior to January 1, 1979.

(3) Four and one-half percent interest for policies issued on or after January 1, 1979.

(d) Applicable tables.--Together with the requirements under subsection (c), the tables and other provisions of this section shall govern:

(1) For ordinary policies of life insurance issued on the standard basis, excluding disability and accidental death benefits in these policies, the following tables shall apply:

(i) The Commissioners 1941 Standard Ordinary Mortality Table for policies issued prior to the operative date of section 410A(d)(2) of The Insurance Company Law of 1921.

(ii) The Commissioners 1958 Standard Ordinary Mortality Table for policies issued on or after the operative date of section 410A(d)(2) of The Insurance Company Law of 1921 and prior to the operative date of section 410A(e) of The Insurance Company Law of 1921. For policies issued on female risks, all modified net premiums and present values referred to in this subparagraph may be calculated according to any age not more than six years younger than the actual age of the insured.

(iii) For policies issued on or after the operative date of section 410A(e) of The Insurance Company Law of 1921, the calculation shall be in accordance with the following tables as specified by regulation:

(A) The Commissioners 1980 Standard Ordinary Mortality Table.

(B) At the election of the company for any one or more specified plans of life insurance, the Commissioners 1980 Standard Ordinary Mortality Table with Ten-Year Select Mortality Factors.

(C) Any ordinary mortality table that is adopted after 1980 by NAIC and approved by regulation for use in determining the minimum standard of valuation for the policies.

(2) For industrial life insurance policies issued on the standard basis, excluding disability and accidental death benefits in these policies, the following tables shall apply:

(i) The 1941 Standard Industrial Mortality Table for policies issued prior to the operative date of section 410A(d)(3) of The Insurance Company Law of 1921.

(ii) For policies issued on or after the operative date of section 410A(d)(3) of The Insurance Company Law of 1921, the Commissioners 1961 Standard Industrial Mortality Table or any industrial mortality table that is adopted after 1980 by NAIC and approved by regulation for use in determining the minimum standard of valuation for the policies.

(3) For individual annuity and pure endowment contracts, excluding disability and accidental death benefits in these policies, any of the following shall apply:

(i) The 1937 Standard Annuity Mortality Table.

(ii) At the option of the company, the Annuity Mortality Table for 1949, Ultimate.

(iii) Any modification of either of the tables under subparagraphs (i) and (ii) as approved by the commissioner.

(4) For group annuity and pure endowment contracts, excluding disability and accidental death benefits in the contracts, any of the following shall apply:

(i) The Group Annuity Mortality Table for 1951 or any modification of the table approved by the commissioner, with interest at 3.5%.

(ii) At the option of the company, the 1971 Group Annuity Mortality Table or any modification of the table approved by the commissioner, in which event 5% interest shall be used in determining the minimum standard for the valuation of the contracts.

(iii) At the option of the company, any of the tables or modifications of tables specified for individual annuity and pure endowment contracts.

(5) For total and permanent disability benefits in or supplementary to ordinary policies or contracts, the following shall apply:

(i) For policies or contracts issued on or after January 1, 1966:

(A) the tables of Period 2 disablement rates and the 1930 to 1950 termination rates of the 1952 Disability Study of the Society of Actuaries, with due regard to the type of benefit; or

(B) any tables of disablement rates and termination rates that are adopted after 1980 by NAIC and approved by regulation for use in determining the minimum standard of valuation for the policies or contracts.

(ii) For policies or contracts issued on or after January 1, 1961, and prior to January 1, 1966:

(A) any of the tables under subparagraph (i); or

(B) at the option of the company, the Class (3) Disability Table (1926).

(iii) For policies issued prior to January 1, 1961, the Class (3) Disability Table (1926). A table under this paragraph shall, for active lives, be combined with a mortality table permitted for calculating the reserves for life insurance policies.

(6) For accidental death benefits in or supplementary to policies, the following shall apply:

(i) For policies issued on or after January 1, 1966:

(A) the 1959 Accidental Death Benefits Table; or

(B) any accidental death benefits table that is adopted after 1980 by NAIC and approved by regulation for use in determining the minimum standard of valuation for the policies.

(ii) For policies issued on or after January 1, 1961, and prior to January 1, 1966:

(A) any of the tables under subparagraph (i); or

(B) at the option of the company, the Inter-Company Double Indemnity Mortality Table.

(iii) For policies issued prior to January 1, 1961, the Inter-Company Double Indemnity Mortality Table. A table under this paragraph shall be combined with a mortality table permitted for calculating the reserves for life insurance policies.

(7) For group life insurance, life insurance issued on the substandard basis and other special benefits, those tables approved by the commissioner shall apply. Cross References. Section 7115 is referred to in sections 7103, 7118, 7122 of this title.
40 Pa.C.S. § 3503 — PA Code / Title 40 / Chapter 35 / Section 3503
Contents of plan of conversion.
Status: in_force

(a) Contents.--The following provisions shall be included in a plan of conversion:

(1) The reasons for proposed conversion.

(2) The effect of conversion on existing policies, including a provision that the policies in force on the effective date of conversion continue to remain in force under the terms of the policies, except that the following

rights, to the extent they existed in the reciprocal insurer, shall be extinguished on the effective date of the conversion:

(i) The voting rights of the subscribers provided under the policies.

(ii) The right to share in the surplus of the reciprocal insurer provided for under the policies.

(iii) The assessment provisions provided for under the policies.

(3) The grant of subscription rights to eligible subscribers, including all of the following:

(i) A provision that each eligible subscriber is to receive, without payment, nontransferable subscription rights to purchase a portion of the capital stock of the stock company and that, in the aggregate, the eligible subscribers may, prior to the right of any other party, purchase 100% of the capital stock of the stock company, exclusive of the shares of capital stock required to be sold or distributed to the holders of surplus notes or the shares of capital stock required to be sold or distributed to subscribers under the reciprocal insurer's constituent documents.

(ii) As an alternative to subscription rights in the stock company, the plan may provide that each eligible subscriber is to receive, without payment, nontransferable subscription rights to purchase a portion of the capital stock of one of the following:

(A) the attorney or a holding company that will act as the holding company for the stock company and, in either case, will hold the stock of the stock company; or

(B) an insurance company or other corporation that will purchase all the stock of or otherwise acquire the stock company.

(iii) A provision that the subscription rights shall be allocated in whole shares among the eligible subscribers using a fair and equitable formula. This formula may, but need not, take into account how the different classes of policies of the eligible subscribers contributed to the surplus of the reciprocal insurer or any other factors that may be fair or equitable.

(b) Oversubscription.--The plan shall provide a fair and equitable means for allocating shares of capital stock in the event of an oversubscription to shares by eligible subscribers exercising subscription rights received under subsection (a)(3).

(c) Shares not subscribed.--The plan shall provide that a share of capital stock not subscribed to by an eligible subscriber exercising subscription rights received under subsection (a)(3) shall be sold in a public offering through an underwriter or in another transaction approved by the commissioner. If the number of shares of capital stock not subscribed by eligible subscribers is so small in number or other factors exist that do not warrant the time or expense of a public offering, the plan of conversion may provide for sale of the unsubscribed shares through a private placement or other alternative method approved by the commissioner that is fair and equitable to eligible subscribers.

(d) Market value of capital stock.--The following shall apply:

(1) The plan shall set the price of the capital stock equal to the estimated pro forma market value of the stock

company as successor to the reciprocal insurer based upon an independent evaluation by a qualified expert.

(2) The pro forma market value may be the value that is estimated to be necessary to attract full subscription for the shares, as indicated by the independent evaluation and may be stated as a range of pro forma market value.

(3) If the attorney is a party to the conversion either as the entity that grants subscription rights to subscribers or the attorney is simultaneously acquired by the stock company in connection with the conversion, the incremental value of the attorney shall be included in the estimate of pro forma market value of the stock company as successor to the reciprocal insurer.

(4) The qualified expert shall consider the effect on the pro forma market value of a right of subscribers to a return of capital contained in the subscriber agreement or other operative document of the reciprocal insurer.

(e) Purchase price of capital stock and minimum subscription amount.--The plan shall set the purchase price per share of capital stock equal to a reasonable amount. The minimum subscription amount required of an eligible subscriber, however, cannot exceed $500, but the plan may provide that the minimum number of shares a person may purchase under the plan is 25 shares.

(f) Limitation on amount of capital stock purchase.--The plan shall provide that a person or group of persons acting in concert may not acquire, in the public offering or under the exercise of subscription rights, more than 5% of the capital stock of the stock company or the stock of another corporation that is participating in the conversion plan, as provided in subsection (a)(3)(i), except with the approval of the commissioner. The limitation does not apply to an entity that is to purchase 100% of the capital stock of the converted company as part of the plan of conversion approved by the commissioner.

(g) Limitation on directors and officers.--The plan shall provide that a director or officer or person acting in concert with a director or officer of the reciprocal insurer or the attorney may not acquire capital stock of the stock company or the stock of another corporation that is participating in the conversion plan, as provided in subsection (a)(3)(i), for three years after the effective date of the plan, except through a broker-dealer, without the permission of the commissioner. This subsection does not prohibit the directors and officers from making a block purchase of 1% or more of the outstanding common stock:

(1) other than through a broker-dealer if approved in writing by the department;

(2) through the exercise of subscription rights received under the plan; or

(3) from participation in a stock benefit plan approved by shareholders under section 3509(b) (relating to conflict of interest).

(h) Sale of stock by directors and officers.--The plan shall provide that a director or officer may not sell stock purchased under this section or section 3504(a) (relating to optional provisions of plan of conversion) within one year after the effective date of the conversion.

(i) Holders of surplus notes.--The plan shall provide that the rights of a holder of a surplus note to participate in the conversion shall be governed by the terms of the surplus note and the rights of subscribers to a return of capital shall be

governed by the subscriber agreement or other operative document of the reciprocal insurer.

(j) Repurchase of capital stock.--The plan shall provide that, without the prior approval of the commissioner, a stock company, or a corporation participating in the conversion plan under subsection (a)(3)(i), may not for a period of three years from the date of the completion of the conversion repurchase any of its capital stock from a person. The restriction under this subsection shall not apply to either:

(1) a repurchase on a pro rata basis under an offer made to the shareholders of the stock company or a corporation participating in the conversion plan under subsection (a)(3)(i); or

(2) a purchase in the open market by a tax-qualified or nontax-qualified employee stock benefit plan in an amount reasonable and appropriate to fund the plan. Cross References. Section 3503 is referred to in sections 3502, 3504, 3505, 3509, 3517 of this title.
40 Pa.C.S. § 9506 — PA Code / Title 40 / Chapter 95 / Section 9506
Payment of coverage and administrative costs.
Status: in_force

(a) General rule.--Consistent with Federal requirements, the department shall pay the following from the Reinsurance Fund:

(1) Administrative expenses of the reinsurance program, including the annual audit required under section 9508 (relating to annual audit).

(2) Reinsurance payments for coverage of reinsurance-eligible enrollees.

(b) Operations.--The department may promulgate regulations necessary and appropriate to establish processes for the settlement of reinsurance coverage claims and disbursement of reinsurance money.

(c) Request for review.--An insurer that is aggrieved by a determination of the department relating to the amount of reinsurance payments due to the insurer may file a request for administrative review of the decision. The procedures and requirements of 2 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of Commonwealth agencies) shall apply to requests for review filed under this section. Notwithstanding otherwise applicable time limitations, in order to permit timely finalization of rates for the open enrollment period for the exchange, a challenge to the department's determination of the attachment point, reinsurance cap and coinsurance rate published in the Pennsylvania Bulletin under section 9504(c) (relating to reinsurance parameters) must be made within 10 business days of the date of publication.
40 Pa.C.S. § 4513 — PA Code / Title 40 / Chapter 45 / Section 4513
Information security program.
Status: in_force

(a) Requirement for implementation and objectives.--Each licensee shall develop, implement and maintain a comprehensive written information security program based on the licensee's risk assessment that:

(1) Contains administrative, technical and physical safeguards for the protection of nonpublic information and the licensee's information systems.

(2) Is commensurate with the following:

(i) The size and complexity of the licensee.

(ii) The nature and scope of the licensee's activities, including the licensee's use of third-party service providers.

(iii) The sensitivity of the nonpublic information used by the licensee or in the licensee's possession, custody or control.

(3) Is designed to protect:

(i) The security and confidentiality of nonpublic information and the security of the information systems.

(ii) Against any threats or hazards to the security or integrity of nonpublic information and the information systems.

(iii) Against unauthorized access to or use of nonpublic information and that minimizes the likelihood of harm to a consumer.

(4) Defines and periodically reevaluates a schedule for retention of nonpublic information and a mechanism for its destruction when no longer needed.

(b) Designation of responsibility.--A licensee shall designate one or more employees, an affiliate or an outside vendor to act on behalf of the licensee who shall be responsible for the information security program of the licensee.

(c) Standards.--A licensee shall develop an information security program based on its risk assessment and shall:

(1) Design its information security program to mitigate the identified risks, in a manner that is commensurate with the following:

(i) The size and complexity of the licensee.

(ii) The nature and scope of the licensee's activities, including the licensee's use of third-party service providers.

(iii) The sensitivity of the nonpublic information used by the licensee or in the licensee's possession, custody or control.

(2) Determine which security measures are appropriate and implement the security measures by:

(i) Placing access controls on information systems, including controls to authenticate and permit access only to authorized individuals to protect against the unauthorized acquisition of nonpublic information.

(ii) Identifying and managing the data, personnel, devices, systems and facilities that enable the licensee to achieve business purposes in accordance with their relative importance to business objectives and the licensee's risk strategy.

(iii) Restricting physical access to nonpublic information only to authorized individuals.

(iv) Protecting, by encryption or other appropriate means, all nonpublic information transmitted over an external network and all nonpublic information stored on a laptop computer or other portable computing or storage device or media.

(v) Adopting secure development practices for in-house developed applications utilized by the licensee.

(vi) Modifying the information systems in accordance with the licensee's information security program.

(vii) Utilizing effective controls, which may include multifactor authentication procedures, for any employees accessing nonpublic information.

(viii) Regularly testing and monitoring systems and procedures to detect actual and attempted attacks on, or intrusions into, information systems.

(ix) Including audit trails within the information security program designed to detect and respond to cybersecurity events and designed to reconstruct material financial transactions sufficient to support normal operations and obligations of the licensee.

(x) Implementing measures to protect against destruction, loss or damage of nonpublic information due to environmental hazards, such as fire and water damage or other catastrophes or technological failures.

(xi) Developing, implementing and maintaining procedures for the secure disposal of nonpublic information in any format.

(3) Include cybersecurity risks in the licensee's enterprise risk management process.

(4) Stay informed regarding emerging threats or vulnerabilities and utilize security measures when sharing information relative to the character of the sharing and the type of information shared.

(5) Provide its personnel with cybersecurity awareness training that is updated as necessary to reflect risks identified by the licensee in the risk assessment.

(d) Monitoring, evaluation and adjustment.--A licensee shall monitor, evaluate and adjust, as appropriate, the information security program consistent with:

(1) Any relevant changes in technology.

(2) The sensitivity of the licensee's nonpublic information.

(3) Internal or external threats to information.

(4) The licensee's own changing business arrangements, such as mergers and acquisitions, alliances and joint ventures, outsourcing arrangements and changes to information systems.

(e) Incident response plan.--As part of its information security program, each licensee shall establish and maintain a written incident response plan designed to promptly respond to, and recover from, any cybersecurity event that compromises the confidentiality, integrity or availability of nonpublic information in its possession, the licensee's information systems or the continuing functionality of any aspect of the

licensee's business or operations. The incident response plan shall address the following areas:

(1) The internal process for responding to a cybersecurity event.

(2) The goals of the incident response plan.

(3) The definition of clear roles, responsibilities and levels of decision-making authority.

(4) External and internal communications and information sharing.

(5) Identification of requirements for the remediation of any identified weaknesses in information systems and associated controls.

(6) Documentation and reporting regarding cybersecurity events and related incident response activities.

(7) The evaluation and revision of the incident response plan following a cybersecurity event, as necessary. Cross References. Section 4513 is referred to in sections 4514, 4516, 4521, 4532, 4536 of this title.
40 Pa.C.S. § 9502 — PA Code / Title 40 / Chapter 95 / Section 9502
Implementation of waiver and establishment of reinsurance program.
Status: in_force

(a) Implementation.--Upon approval of the department's application for an innovation waiver by the United States Department of Health and Human Services, the department shall implement a reinsurance program.

(b) Establishment.--Contingent upon Federal approval, the Commonwealth Health Insurance Reinsurance Program is established in the department for the purposes of stabilizing the rates and premiums for health insurance policies in the individual market and providing greater financial certainty to consumers of health insurance in this Commonwealth. The reinsurance program shall be considered a reinsurance entity to carry out a reinsurance program under the Federal acts.

(c) Operation.--Operation of a reinsurance program shall be contingent on Federal approval of the waiver application submitted pursuant to section 9501 (relating to application). Cross References. Section 9502 is referred to in sections 9103, 9305, 9510 of this title.
40 Pa.C.S. § 7132 — PA Code / Title 40 / Chapter 71 / Section 7132
General rule for confidential information.
Status: in_force

Except as otherwise provided in this subchapter, confidential information shall be privileged and given confidential treatment and shall not be:

(1) Subject to discovery or admissible as evidence in a private civil action.

(2) Subject to subpoena.

(3) Subject to the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law. Cross References. Section 7132 is referred to in section 7137 of this title.
40 Pa.C.S. § 9310 — PA Code / Title 40 / Chapter 93 / Section 9310
Audits.
Status: in_force

(a) Annual audit.--The accounts and books of the exchange authority shall be examined and audited annually by an independent certified public accounting firm. The audit shall at a minimum:

(1) Assess compliance with the requirements of this chapter.

(2) Identify any material weaknesses or significant deficiencies and identify ways to correct the material weaknesses or deficiencies.

(b) Sharing of audit.--By December 31 of each year, the exchange authority shall electronically share the audit of the preceding fiscal year required under subsection (a) and related documents by:

(1) Posting the following on the exchange authority's publicly accessible Internet website:

(i) The audit.

(ii) A summary of the audit, including any material weakness or significant deficiency identified and how the exchange authority intends to correct the material weakness or significant deficiency.

(2) Providing an electronic link to the posted audit under paragraph (1)(i) to the Secretary of the Senate and the Chief Clerk of the House of Representatives.

(3) Providing an electronic link to the posted audit under paragraph (1)(i) to the department.

(c) Payment.--The cost of the annual audit required under subsection (a) shall be paid for from money in the exchange fund. Cross References. Section 9310 is referred to in section 9307 of this title.
40 Pa.C.S. § 9509 — PA Code / Title 40 / Chapter 95 / Section 9509
Annual report of operations.
Status: in_force

(a) Report.--No later than November 1 of the year following the applicable benefit year or 60 calendar days following the final disbursement of reinsurance payments for the applicable benefit year, whichever is later, the department shall prepare a financial report for the applicable benefit year. The report must include, at a minimum, the following information for the benefit year that is the subject of the report:

(1) Money deposited into the Reinsurance Fund.

(2) Requests for reinsurance payments received from eligible insurers.

(3) Reinsurance payments made to eligible insurers.

(4) Administrative and operational expenses incurred for the reinsurance program.

(b) Comparative report.--No later than 60 days after individual market health insurance rates are final, the department shall prepare a report summarizing the quantifiable impact of the reinsurance program on individual market health insurance rates for the following plan year.

(c) Distribution of reports.--The department shall:

(1) Electronically transmit the reports under this section to:

(i) The President pro tempore of the Senate.

(ii) The Minority Leader of the Senate.

(iii) The Speaker of the House of Representatives.

(iv) The Minority Leader of the House of Representatives.

(v) The chair and minority chair of the Appropriations Committee of the Senate and the chair and minority chair of the Appropriations Committee of the House of Representatives.

(vi) The chair and minority chair of the Banking and Insurance Committee of the Senate and the chair and minority chair of the Insurance Committee of the House of Representatives.

(2) Post the reports under this section on the department's publicly accessible Internet website. Cross References. Section 9509 is referred to in section 9513 of this title.
40 Pa.C.S. § 6308 — PA Code / Title 40 / Chapter 63 / Section 6308
Uncertificated plans prohibited.
Status: in_force

(a) General rule.--It shall be unlawful for any person, other than a professional health service corporation holding a certificate of authority under this chapter relating to the plan being maintained or operated by such corporation, to establish, maintain or operate in this Commonwealth a nonprofit dental service plan, a nonprofit optometric service plan, or a nonprofit professional health service plan.

(b) Exemptions.--Nothing in subsection (a) of this section shall be construed as preventing any person from furnishing professional health services for the prevention of disease among his employees or from furnishing any of such services as required under The Pennsylvania Workmen's Compensation Act and related statutes, when the employee is not charged for such service. References in Text. The short title of the act of June 2, 1915, P.L.736, No.338, known as The Pennsylvania Workmen's Compensation Act, referred to in subsec. (b), was amended by the act of July 2, 1993, P.L.190, No.44. The amended short title is now the Workers' Compensation Act.
40 Pa.C.S. § 7119 — PA Code / Title 40 / Chapter 71 / Section 7119
Reserve valuation method for annuity and pure endowment benefits.
Status: in_force

(a) Applicability.--This section shall apply to all annuity and pure endowment contracts other than group annuity and pure endowment contracts purchased under a retirement plan or plan of deferred compensation, established or maintained by an employer, including a partnership or sole proprietorship, or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under section 408 of the Internal Revenue Code of 1986 (Public Law 99-514, 26 U.S.C. § 408).

(b) Calculation.--The following shall apply:

(1) Reserves according to the commissioners annuity reserve method for benefits under annuity or pure endowment contracts, excluding any disability and accidental death benefits in the contracts, shall be the greatest of the respective excesses of the present values, at the date of valuation, of the future guaranteed benefits, including guaranteed nonforfeiture benefits, provided for by the contracts at the end of each respective contract year, over the present value, at the date of valuation, of any future valuation considerations derived from future gross considerations, required by the terms of the contract, that become payable prior to the end of the respective contract year.

(2) The future guaranteed benefits shall be determined by using the mortality table, if any, and the interest rate or rates specified in the contracts for determining guaranteed benefits.

(3) The valuation considerations shall be the portions of the respective gross considerations applied under the terms of the contracts to determine nonforfeiture values. Cross References. Section 7119 is referred to in sections 7103, 7115, 7116, 7118, 7120, 7123 of this title.
40 Pa.C.S. § 3905 — PA Code / Title 40 / Chapter 39 / Section 3905
Review of CGAD.
Status: in_force

(a) Procedures for review.--The review of the CGAD and any additional requests for information shall be made by or through the lead state or, in the case of an insurer that is not part of an insurance group, the department.

(b) Duplicative filings.--An insurer or insurance group providing information substantially similar to the information required by this chapter in other documents provided to the department, including proxy statements filed in conjunction with registration requirements or other Federal or State filings provided to the department, is not required to duplicate that

information in the CGAD but shall only be required to cross-reference the document in which the information is included.
40 Pa.C.S. § 4805 — PA Code / Title 40 / Chapter 48 / Section 4805
Standard of care.
Status: in_force

A health care provider providing health care services through telemedicine shall be subject to the same standard of care that would apply to the health care services in an in-person setting.
40 Pa.C.S. § 4710 — PA Code / Title 40 / Chapter 47 / Section 4710
Violations.
Status: in_force

(a) Penalties and remedies.--Upon a determination by hearing that this chapter has been violated, the commissioner may pursue one or more of the following courses of action:

(1) Issue an order requiring the person in violation to cease and desist from engaging in the violation.

(2) Suspend or revoke or refuse to issue or renew the certificate or license of the person in violation.

(3) Impose a civil penalty of not more than $5,000 for each violation.

(4) Impose any other penalty or remedy deemed appropriate by the commissioner, including restitution.

(b) Other remedies.--

(1) The enforcement remedies imposed under this section are in addition to any other remedies or penalties that may be imposed by any other applicable statute, including the act of July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance Practices Act.

(2) A violation of this chapter is deemed and defined by the commissioner to be an unfair method of competition and an unfair or deceptive act or practice in accordance with the Unfair Insurance Practices Act.
40 Pa.C.S. § 3502 — PA Code / Title 40 / Chapter 35 / Section 3502
Adoption of plan of conversion.
Status: in_force

(a) Plan of conversion.--The following shall apply:

(1) A plan of conversion may not become effective unless the reciprocal insurer seeking to convert to a stock company has adopted:

(i) by the affirmative vote of not less than two-thirds of the subscribers' advisory committee or an equivalent governing body of the reciprocal insurer; or

(ii) in the absence of a governing body, by the board of directors or governing body of the attorney for the reciprocal insurer, a plan of conversion consistent with the requirements of sections 3503 (relating to contents of plan of conversion) and 3504 (relating to optional provisions of plan of conversion).

(2) Before approval of a plan by the commissioner, the reciprocal insurer may amend or withdraw the plan under paragraph (1) by the affirmative vote of not less than two-thirds of:

(i) its subscribers' advisory committee or an equivalent governing body of the reciprocal insurer; or

(ii) in the absence of a governing body, by the board of directors or governing body of the attorney for the reciprocal insurer.

(b) Eligible subscriber.--A person insured under a group policy that is otherwise an eligible subscriber also shall be an eligible subscriber. A person whose policy becomes effective after the adoption of the plan or the voting record date, if a later date, but before the plan's effective date is not an eligible subscriber but shall have the rights established under section 3507 (relating to rights of subscribers whose policies are issued after adoption of plan and before effective date).

(c) Documents.--The following shall apply:

(1) Before a reciprocal insurer's eligible subscribers may vote on approval of a plan, the reciprocal insurer or the attorney shall file the following documents with the commissioner within 90 days after adoption of the plan:

(i) the plan of conversion, including the independent evaluation of pro forma market value required under section 3503(d).

(ii) the form of notice required under subsection

(g);

(iii) the form of proxy to be solicited from eligible subscribers under subsection (h);

(iv) the form of notice required under section 3508 (relating to corporate existence) to persons whose policies are issued after adoption of the plan but before its effective date;

(v) the proposed articles of incorporation and bylaws of the stock company;

(vi) the acquisition of control statement, as required under section 1402 of the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921; and

(vii) other information as the commissioner may request.

(2) Upon filing of the documents required under this subsection with the commissioner, the reciprocal insurer shall send to eligible subscribers a notice advising eligible subscribers of:

(i) the adoption and filing of the plan;

(ii) the ability of subscribers to provide the commissioner and the reciprocal insurer with comments on the plan within 30 days of the date of the notice; and

(iii) the procedure for making comments.

(d) Notice and approval of plan.--The commissioner shall immediately give written notice to the reciprocal insurer of a decision and, in the event of disapproval, a statement in detail of the reasons for the decision. The commissioner shall approve the plan if the commissioner finds the following:

(1) the plan complies with this chapter;

(2) the plan will not prejudice the interests of the subscribers; and

(3) the plan's method of allocating subscription rights is fair and equitable.

(e) Experts.--At the reciprocal insurer's expense, the commissioner may retain a qualified expert not otherwise a part of the commissioner's staff to assist in reviewing the plan and the independent evaluation of the pro forma market value required under section 3503(d).

(f) Hearing.--The commissioner may order a hearing on whether the terms of the plan comply with this chapter after giving written notice to the reciprocal insurer and other interested persons, all of whom have the right to appear at the hearing.

(g) Notice of subscribers' meeting.--The following shall apply:

(1) Eligible subscribers shall be sent notice of the subscribers' meeting to vote upon the plan. The notice must:

(i) briefly but fairly describe the proposed conversion plan;

(ii) inform the subscriber of the subscriber's right to vote upon the plan; and

(iii) be sent to each subscriber's last known address, as shown on the reciprocal insurer's records, at least 30 days before the time fixed for the meeting.

(2) If the reciprocal insurer holds an annual meeting of subscribers and the meeting to vote upon the plan is held at the annual meeting, only a combined notice of meeting is required.

(h) Voting.--The plan shall be voted upon by eligible subscribers and shall be deemed approved upon receiving the affirmative vote of at least two-thirds of the votes cast by eligible subscribers. Unless the governing documents of the reciprocal insurer establish a different date, the record date for determining subscribers eligible to vote on the plan shall be the date of adoption of the plan or other date set forth in the plan that shall be no less than 30 nor more than 90 days before the date of the meeting. Eligible subscribers entitled to vote upon the proposed plan may vote in person or by proxy. Unless the governing documents of the reciprocal insurer provide otherwise, an eligible subscriber may cast one vote.

(i) Approval of plan.--A merger of the reciprocal insurer with and into the stock company must be approved at the meeting of the subscribers called for the purpose of approving the plan of conversion and shall require for approval or ratification the affirmative vote of at least two-thirds of the votes cast by eligible subscribers.

(j) Documents to be filed following approval.--Within 30 days after the eligible subscribers approved the plan, the stock company shall file the following documents with the commissioner:

(1) the minutes of the meeting of the eligible subscribers at which the plan was approved;

(2) the articles of incorporation and bylaws of the stock company; and

(3) articles of merger for the merger of the reciprocal insurer with and into the stock company. The plan shall be consummated upon the filing of the articles of merger.
40 Pa.C.S. § 6334 — PA Code / Title 40 / Chapter 63 / Section 6334
Dissolution or liquidation.
Status: in_force

No professional health service corporation shall be dissolved under the provisions of Title 15 (relating to corporations and unincorporated associations) or under any other provision of law, except with the prior approval of the department. Articles of dissolution for a professional health service corporation filed in the Department of State, whether pursuant to a decree of court liquidating the corporation or otherwise, shall not be effective unless and until approved by the Insurance Department. Any dissolution or liquidation of a professional health service corporation shall be under the supervision of the Insurance Department which shall have all powers with respect thereto granted to it under the laws of this Commonwealth governing the dissolution or liquidation of insurance companies.
40 Pa.C.S. § 3702 — PA Code / Title 40 / Chapter 37 / Section 3702
Definitions.
Status: in_force

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:

"Beneficiary." A person designated to receive the proceeds from a life insurance policy or retained asset account.

"Commissioner." The Insurance Commissioner of the Commonwealth.

"Contract." An annuity contract. The term shall not include an annuity used to fund an employment-based retirement plan or program where:

(1) the insurer does not perform the recordkeeping services; or

(2) the insurer is not committed by terms of the annuity contract to pay death benefits to the beneficiaries of specific plan participants.

"Death master file." The Social Security Administration's death master file or any other database or service that is at least as comprehensive for determining that an individual has reportedly died.

"Death master file match." A search of the death master file that results in a match of the Social Security number or the name and date of birth of an insured, annuity owner or retained asset account holder.

"Department." The Insurance Department of the Commonwealth.

"Insured." An individual covered by a life insurance policy.

"Insurer." A person licensed in this Commonwealth to sell life insurance policies or annuity contracts as any of the following:

(1) A single insurance entity.

(2) An insurer under a parent organization that sells annuities using a different charter. The term as used in this chapter shall not include a fraternal benefit society.

"Knowledge of death." Either of the following:

(1) receipt of an original or valid copy of a certified death certificate; or

(2) a death master file match validated by the insurer in accordance with section 3703(a) (relating to death master file comparison).

"Policy." A policy or certificate of life insurance that provides a death benefit. The term shall not include:

(1) a policy or certificate of life insurance that provides a death benefit under an employee benefit plan subject to the Employee Retirement Income Security Act of 1974 (Public Law 93-406, 88 Stat. 829), as periodically amended, or under any Federal employee benefits program;

(2) a policy or certificate of life insurance that is purchased in conjunction with a preneed funeral contract or prearrangement;

(3) a policy or certificate of credit life or accidental death insurance; or

(4) a policy issued to a group master policyholder for which the insurer does not provide recordkeeping services.

"Recordkeeping services." Those circumstances under which an insurer has agreed with a group policy or contract customer to be responsible for obtaining, maintaining and administering in its own or its agents' systems at least the following information about each individual insured under an insured's group insurance contract, or a line of coverage under the contract:

(1) Social Security number or name and date of birth;

(2) beneficiary designation information;

(3) coverage eligibility;

(4) benefit amount; and

(5) premium payment status.

"Retained asset account." A mechanism whereby the settlement of proceeds payable under a policy or contract is accomplished by the insurer or an entity acting on behalf of the insurer depositing the proceeds into an account with check or draft writing privileges, where those proceeds are retained by the insurer or its agent, pursuant to a supplementary contract not involving annuity benefits other than death benefits.
40 Pa.C.S. § 9510 — PA Code / Title 40 / Chapter 95 / Section 9510
Reinsurance Fund.
Status: in_force

(a) Establishment and administration of Reinsurance Fund.--The Reinsurance Fund is established as a special fund within the State Treasury. The Reinsurance Fund shall be administered by the department for the purposes set forth in this chapter, including the deposit of Federal money and all other money received pursuant to and disbursements permitted by this chapter.

(b) Exclusive purpose.--The Reinsurance Fund shall be dedicated exclusively for the reinsurance program established under section 9502(b) (relating to implementation of waiver and establishment of reinsurance program).

(c) Use.--The following apply:

(1) Expenditures from the Reinsurance Fund shall be used to:

(i) Implement and operate the reinsurance program.

(ii) Make reinsurance payments to eligible insurers under the reinsurance program. Payments to insurers shall be calculated and made on a pro rata basis.

(2) In making expenditures from the Reinsurance Fund, available Federal money must be expended first.

(3) Pending disbursement, money in the Reinsurance Fund shall be invested or reinvested in the same manner as money in the custody of the State Treasurer. All earnings received from the investment or reinvestment of money shall be credited to the Reinsurance Fund.

(d) Expenses.--All costs and expenses of the reinsurance program shall be paid from the Reinsurance Fund, including compensation of employees and any independent contractors or consultants hired by the department.

(e) Nonlapsing and revolving fund.--The following apply:

(1) The Reinsurance Fund shall be a nonlapsing fund. All money placed in the Reinsurance Fund and interest accrued are appropriated to the department for expenditure consistent with the provisions of this chapter.

(2) Nothing in this section shall prevent money in the Reinsurance Fund from being used as a revolving fund to cover necessary expenditures if Federal money is requested and committed but not yet received or if other money is committed but not yet received.

(f) Limitations.--The following limitations apply:

(1) In each fiscal year, the total amount of annual expenditures from the Reinsurance Fund, including administrative and consulting expenses, may not exceed the amount of expected Federal and other money budgeted for deposit in the Reinsurance Fund in that fiscal year.

(2) Notwithstanding any general or specific powers granted to the department under this chapter, whether express or implied, the department may not pledge, in favor of the reinsurance program, the credit or taxing power of the Commonwealth or any political subdivision. Cross References. Section 9510 is referred to in section 9305 of this title.
40 Pa.C.S. § 3507 — PA Code / Title 40 / Chapter 35 / Section 3507
Rights of subscribers whose policies are issued after adoption of plan and before effective date.
Status: in_force

(a) Notice.--A subscriber shall be sent a written notice regarding the plan upon issuance of a policy if the subscriber's policy is issued after the later of:

(1) the date the proposed plan has been adopted; or

(2) if different, the record date for establishing subscribers eligible to vote on the plan. The notice shall be sent before the effective date of the plan.

(b) Cancellation and refund.--A subscriber entitled to receive the notice provided for in subsection (a) shall be advised of the subscriber's right of cancellation and to a pro rata refund of unearned premiums.

(c) Limitation on subscribers.--A subscriber who has made or filed a claim under the subscriber's insurance policy may not receive a refund under subsection (b). A person who has exercised the rights provided under subsection (b) may not make or file a claim under the subscriber's insurance policy. Cross References. Section 3507 is referred to in section 3502 of this title.
40 Pa.C.S. § 9102 — PA Code / Title 40 / Chapter 91 / Section 9102
Purpose and intent.
Status: in_force

The General Assembly finds and declares as follows:

(1) The Commonwealth intends to maintain the Commonwealth's sovereignty over the regulation of health insurance in this Commonwealth.

(2) The health insurance marketplace in this Commonwealth is unique and unlike the marketplace in any other state.

(3) It is necessary to maintain the Commonwealth's sovereignty over the regulation of health insurance in this Commonwealth as permitted by Federal law, including the Federal acts. The provisions of this part are intended to meet these requirements while retaining the Commonwealth's authority to regulate health insurance in this Commonwealth.
40 Pa.C.S. § 3514 — PA Code / Title 40 / Chapter 35 / Section 3514
Laws applicable to stock company.
Status: in_force

(a) Control of stock company.--A reciprocal insurer may not convert under this chapter if, as a direct result of the conversion, a person or the person's affiliates acquire control of the stock company, unless that person and the person's affiliates comply with the provisions of section 1402 of the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921. For purposes of this subsection, the term "control" shall have the meaning provided in section 1401 of The Insurance Company Law of 1921.

(b) Stock insurance company rules.--Except as otherwise specified in this chapter, a stock company resulting from the conversion of a reciprocal insurer under this chapter shall have and may exercise the rights and privileges and shall be subject to the requirements and regulations imposed upon stock insurance companies formed under this act and other laws of this Commonwealth relating to the regulation and supervision of insurance companies, but it may not exercise rights or privileges that other stock insurance companies may not exercise.
40 Pa.C.S. § 3802 — PA Code / Title 40 / Chapter 38 / Section 3802
Definitions.
Status: in_force

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:

"Abuse." Incidents or practices of providers, physicians or suppliers of services and equipment which are inconsistent with accepted sound medical, business or fiscal practices.

"Fraud." Any activity defined as an offense under 18 Pa.C.S. § 4117 (relating to insurance fraud).

"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, a physician, chiropractor, optometrist, professional nurse, certified nurse-midwife, podiatrist, hospital, nursing home, ambulatory surgical center or birth center.

"Insurer." A health insurance entity licensed in this Commonwealth to issue any individual or group health, sickness

or accident policy or subscriber contract or certificate that provides medical or health care coverage by a health care facility or licensed health care provider that is offered or governed under any of the following:

(1) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof.

(2) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act.

(3) The act of May 18, 1976 (P.L.123, No.54), known as the Individual Accident and Sickness Insurance Minimum Standards Act.

(4)
40 Pa.C.S. § 3801 — PA Code / Title 40 / Chapter 38 / Section 3801
Scope of chapter.
Status: in_force

This chapter shall not apply to reimbursements made as part of an annual contracted reconciliation of a risk-sharing arrangement under an administrative service provider contract.
40 Pa.C.S. § 5004 — PA Code / Title 40 / Chapter 50 / Section 5004
Changes in hardware or software requirements.
Status: in_force

After a covered person or plan sponsor provides consent in accordance with section 5003 (relating to electronic delivery of insurance notices or documents), if a change in the hardware or software requirements necessary to access or retain a notice or document to be delivered by electronic means creates a material risk such that the covered person will not be able to access or retain the notice or document for which the consent applies, an insurer may not deliver by electronic means a notice or document to the covered person unless the insurer complies with the requirements of section 5003 and provides the covered person with a statement that describes all of the following:

(1) The revised hardware and software requirements for access to and retention of a document delivered by electronic means.

(2) The right of the covered person to opt out of delivery by electronic means without the imposition of a condition or consequence that was not disclosed at the time of initial consent. Cross References. Section 5004 is referred to in section 5007 of this title.
40 Pa.C.S. § 3908 — PA Code / Title 40 / Chapter 39 / Section 3908
Penalties.
Status: in_force

An insurer or insurance group that fails to timely file a CGAD as required under this chapter or by regulation shall be required, after notice and hearing, to pay a penalty of $200 for each day's delay. The maximum penalty under this section shall be $25,000 per year.
40 Pa.C.S. § 3515 — PA Code / Title 40 / Chapter 35 / Section 3515
Licensing of stock company and commencement of business as an insurance company.
Status: in_force

The commissioner may waive the minimum surplus requirement of a stock company in connection with the initial licensing of a stock company that will be the successor to a reciprocal insurer. The stock company may not engage in the business of insurance as a stock company until the completion of the merger with the reciprocal insurer and compliance with the provisions of this chapter.
40 Pa.C.S. § 6102 — PA Code / Title 40 / Chapter 61 / Section 6102
Certification of hospital plan corporations.
Status: in_force

(a) General rule.--A corporation not-for-profit incorporated for the purpose of establishing, maintaining and operating a nonprofit hospital plan shall not commence business until it shall have received from the department a certificate of authority authorizing the corporation to establish, maintain and operate such a nonprofit hospital plan.

(b) Exemption.--The provisions of subsection (a) of this section shall not apply to any nonprofit corporation incorporated with the approval of the department under the former provisions of section 218 of the Nonprofit Corporation Law of 1933. For the purposes of this chapter such a corporation shall be deemed to be a holder of a certificate of authority issued under this section.

(c) Form of application.--Every application for a certificate of authority under this section shall be made to the department in writing and shall be in such form and contain such information as the regulations of the department may require.

(d) Standards for issuance of certificate.--A certificate of authority shall be issued by order of the department only if and when the department shall find and determine that the application complies with the provisions of this chapter and the regulations of the department thereunder.

(e) Procedure before department.--For the purpose of enabling the department to make the finding or determination required by subsection (d) of this section, the department, by publication of notice in the Pennsylvania Bulletin, shall afford reasonable opportunity for hearing, which shall be public, and, before or after any such hearing, it may make such inquiries, audits and investigations, and may require the submission of such supplemental studies and information, as it may deem necessary or proper to enable it to reach a finding or determination. The department, in granting a certificate of authority, may impose such conditions as it may deem to be just and reasonable. In every case the department shall make a finding or determination in writing, stating whether or not the application has been approved, and, if it has been approved in part only, specifying the part which has been approved and the part which has been denied. Any holder of a certificate of authority, exercising the authority conferred thereby, shall be deemed to have waived any and all objections to the terms and conditions of such certificate.

(f) Judicial review.--Orders of the department upon an application for a certificate of authority under this section shall be subject to judicial review in the manner and within the time provided by law. Cross References. Section 6102 is referred to in sections 6124, 6304, 6329 of this title.
40 Pa.C.S. § 5006 — PA Code / Title 40 / Chapter 50 / Section 5006
Rescission of delivery by electronic means.
Status: in_force

(a) Procedures.--No later than 30 days after the effective date of this subsection, an insurer shall develop procedures by which a covered person may opt out of delivery by electronic means.

(b) Legality.--The decision by a covered person to opt out of delivery by electronic means shall not affect the legality or enforceability of a notice or document delivered by electronic means to the covered person before the decision takes effect.

(c) Effect.--The decision by a covered person to opt out of delivery by electronic means shall take effect no later than 30 days after the insurer receives notice of the covered person's decision.
40 Pa.C.S. § 9314 — PA Code / Title 40 / Chapter 93 / Section 9314
Expiration.
Status: in_force

Upon publication of the notice under section 9703(b) (relating to action by commissioner), the exchange authority shall initiate steps to cease operations of the exchange authority and shall cease operations not later than 15 months after publication of the notice.
40 Pa.C.S. § 9308 — PA Code / Title 40 / Chapter 93 / Section 9308
Not an entitlement.
Status: in_force

Nothing in this chapter shall constitute an entitlement derived from the Commonwealth or a claim on any money of the Commonwealth.
40 Pa.C.S. § 5012 — PA Code / Title 40 / Chapter 50 / Section 5012
Regulations.
Status: in_force

The department may promulgate any necessary or appropriate regulations to effectuate this chapter.
40 Pa.C.S. § 6327 — PA Code / Title 40 / Chapter 63 / Section 6327
Subscriptions provided for persons on relief.
Status: in_force

Every government agency which is charged by law with the duty of providing professional health services for persons unable to provide it at their own expense or to procure it through persons to whose support and assistance they are by law entitled, is hereby empowered, in the exercise of its authority, to provide any such service if, in the judgment of the agency, it is in the public interest so to do, through a subscription or subscriptions, paid for from any lawfully available public funds, with any professional health service corporation on behalf of any person or persons entitled to such relief.
40 Pa.C.S. § 3704 — PA Code / Title 40 / Chapter 37 / Section 3704
Applicability.
Status: in_force

This chapter shall not apply to all of the following:

(1) An annuity contract that does not require the insurer to pay benefits to the beneficiary of the policy.

(2) A policy that provides a death benefit under the Employee Retirement Income Security Act of 1974 (Public Law 93-406, 88 Stat. 829).

(3) A Federal employee benefit program.

(4) A policy to fund funeral or burial services.

(5) A policy of credit life insurance or health and accident insurance.
40 Pa.C.S. § 7113 — PA Code / Title 40 / Chapter 71 / Section 7113
Actuarial opinion of reserves prior to operative date of valuation manual.
Status: in_force

(a) Applicability.--This section shall apply to an actuarial opinion prepared prior to the operative date of the valuation manual.

(b) Regulations regarding actuarial opinion.--Through regulations, the commissioner:

(1) Shall define the specifics of the actuarial opinion under this section and add any other items deemed to be necessary to fulfill the purpose of this section.

(2) May provide for a transition period for establishing any higher reserves that the qualified actuary may deem necessary in order to render the opinion required by this section.

(c) Annual submission and purpose.--Each company doing business in this Commonwealth shall annually submit the opinion of a qualified actuary as to whether the reserves and related actuarial items held in support of the company's policies and contracts specified by the commissioner by regulation:

(1) are computed appropriately;

(2) are based on assumptions that satisfy contractual provisions;

(3) are consistent with prior reported amounts; and

(4) comply with the applicable laws of this Commonwealth.

(d) Opinion regarding company obligations.--The following shall apply regarding the opinion of the qualified actuary and the company's obligations:

(1) Except as exempted by regulation, each company shall include in the actuarial opinion required under this section an opinion by the same qualified actuary as to whether the reserves and related actuarial items held in support of the company's policies and contracts specified by the commissioner by regulation, when considered in light of the assets held by the company with respect to the reserves and related actuarial items, including, but not limited to, the investment earnings on the assets and the considerations anticipated to be received and retained under the policies and contracts, make adequate provision for the company's obligations under the policies and contracts, including, but not limited to, the benefits under and expenses associated with the policies and contracts.

(2) A memorandum, in form and substance acceptable to the commissioner as specified by regulation, shall be prepared to support each actuarial opinion.

(3) If a company fails to provide a supporting memorandum at the request of the commissioner within a period specified by regulation or if the commissioner determines that the supporting memorandum provided by the company fails to meet the standards prescribed by regulation or is otherwise unacceptable to the commissioner, the commissioner may engage a qualified actuary at the expense of the company to review the opinion and the basis for the opinion and prepare the supporting memorandum required by the commissioner.

(e) Requirements.--Each actuarial opinion under this section shall be governed by the following:

(1) The opinion shall be submitted with the annual statement reflecting the valuation of the reserve liabilities for each year ending on or after December 31, 1993.

(2) The opinion shall apply to all business in force, including individual and group accident and health insurance plans, in form and substance acceptable to the commissioner as specified by regulation.

(3) The opinion shall be based on standards adopted from time to time by the Actuarial Standards Board, or its successor, and on any additional standards as specified by regulation.

(4) In the case of an opinion required to be submitted by a foreign or alien company, the commissioner may accept the opinion filed by that company with the insurance supervisory official of another state if the commissioner determines that the opinion reasonably meets the requirements applicable to a company domiciled in this Commonwealth.

(5) Except in cases of fraud or willful misconduct, a qualified actuary shall not be liable for damages to any person, other than the insurance company or fraternal benefit society and the commissioner, for any act, error, omission, decision or conduct with respect to the actuarial opinion.

(6) Disciplinary action by the commissioner against the company, fraternal benefit society or the qualified actuary shall be prescribed by regulation.

(7) The confidentiality provisions under Subchapter C (relating to confidentiality) shall apply.

(f) Definitions.--As used in this section, the following words and phrases shall have the meanings given to them in this subsection unless the context clearly indicates otherwise:

"Qualified actuary." A member in good standing of the American Academy of Actuaries who meets the requirements under 31 Pa. Code Ch. 84b (relating to actuarial opinion and memorandum). Cross References. Section 7113 is referred to in sections 7120, 7121, 7131, 7137 of this title.
40 Pa.C.S. § 7131 — PA Code / Title 40 / Chapter 71 / Section 7131
Confidential information defined.
Status: in_force

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

"Confidential information." Any of the following:

(1) A memorandum in support of an opinion submitted under section 7113 (relating to actuarial opinion of reserves prior to operative date of valuation manual) or 7114 (relating to actuarial opinion of reserves on or after operative date of valuation manual) and any other documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with the memorandum.

(2) All documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in the course of an examination made under section 7125(d) (relating to valuation manual for policies issued on or after operative date of valuation manual), except that confidential information shall not include an examination report or other material prepared in connection with an examination made under Article IX of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of 1921, to the extent not held to be private and confidential information under section 905 of The Insurance Department Act of 1921.

(3) Reports, documents, materials and other information developed by a company in support of or in connection with an annual certification by the company under section 7126(b)(2) (relating to requirements of principle-based valuation), which evaluates the effectiveness of the

company's internal controls regarding a principle-based valuation, and any other documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with the reports, documents, materials and other information.

(4) A principle-based valuation report developed under section 7126(b)(3) and any other documents, materials and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with the report.

(5) Experience data, experience materials and any other documents, materials, data and other information, including all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with experience data or experience materials. Cross References. Section 7131 is referred to in section 7137 of this title.
40 Pa.C.S. § 3901 — PA Code / Title 40 / Chapter 39 / Section 3901
Purposes and scope of chapter.
Status: in_force

(a) Purposes.--The purposes of this chapter are to:

(1) Provide the commissioner a summary of an insurer or insurance group's corporate governance structure, policies and practices to permit the commissioner to gain and maintain an understanding of the insurer or insurance group's corporate governance framework.

(2) Outline the requirements for completing and filing a CGAD with the commissioner.

(3) Provide for the confidential treatment of the CGAD and related information containing confidential and sensitive information related to an insurer or insurance group's internal operations and proprietary and trade secret information which, if made public, could potentially cause the insurer or insurance group competitive harm or disadvantage.

(b) Scope.--The requirements of this chapter shall apply to:

(1) an insurer that is domiciled in this Commonwealth; or

(2) an insurance group of which this Commonwealth is the lead state.
40 Pa.C.S. § 4903 — PA Code / Title 40 / Chapter 49 / Section 4903
Regulations.
Status: in_force

The department may promulgate regulations necessary to implement this chapter.
40 Pa.C.S. § 3803 — PA Code / Title 40 / Chapter 38 / Section 3803
Retroactive denial of reimbursement.
Status: in_force

(a) General rule.--Except as provided in section 3804 (relating to exceptions to retroactive denial of reimbursement), an insurer may not retroactively deny reimbursement as a result of an overpayment determination more than 24 months after the date the insurer initially paid the health care provider. An insurer that retroactively denies reimbursement to a health care provider under this chapter shall do so based upon coding guidelines and policies in effect at the time the service subject to the retroactive denial was rendered.

(b) Written notice.--An insurer that retroactively denies reimbursement to a health care provider under subsection (a) shall provide the health care provider with a written statement specifying the basis for the retroactive denial. Cross References. Section 3803 is referred to in sections 3804, 3806 of this title.
40 Pa.C.S. § 4533 — PA Code / Title 40 / Chapter 45 / Section 4533
Rules and regulations.
Status: in_force

The commissioner may issue rules and regulations necessary to carry out the provisions of this chapter.
40 Pa.C.S. § 3508 — PA Code / Title 40 / Chapter 35 / Section 3508
Corporate existence.
Status: in_force

On the effective date of the conversion, the corporate existence of the reciprocal insurer continues in the stock company. On the effective date of the conversion, the assets, rights, franchises and interests of the reciprocal insurer in and to every species of real, personal and mixed property and the accompanying things in action are vested in the stock company without a deed or other instrument of transfer and the stock company assumes the obligations and liabilities of the reciprocal insurer. Cross References. Section 3508 is referred to in section 3502 of this title.
40 Pa.C.S. § 9515 — PA Code / Title 40 / Chapter 95 / Section 9515
Regulation of insurers.
Status: in_force

Nothing in this chapter shall be construed to limit or supersede the regulatory authority vested with the department to regulate the business of insurance within this Commonwealth, including health insurance policies offered on or off the exchange.
40 Pa.C.S. § 4531 — PA Code / Title 40 / Chapter 45 / Section 4531
Confidentiality.
Status: in_force

(a) Requirement.--All information, documents, materials and copies thereof in the possession or control of the department that are produced by, obtained by or disclosed to the department or any other person in the course of an examination or investigation under this chapter shall be privileged and given confidential treatment and:

(1) Shall not be subject to discovery or admissible in evidence in a private civil action.

(2) Shall not be subject to subpoena.

(3) Shall be exempt from access under the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law.

(4) Shall not be made public by the department or any other person, except to regulatory or law enforcement officials of other jurisdictions, without the prior written consent of the licensee to which it pertains, except as provided in subsection (c).

(b) Civil actions.--The commissioner, department or any person that receives documents, materials or other information while acting under the authority of the commissioner or department or with whom the documents, materials or other information are shared under this chapter may not be permitted or required to testify in a private civil action concerning confidential documents, materials or information covered under subsection (a).

(c) Department actions.--To assist in the performance of the regulatory duties under this chapter, the department:

(1) May share documents, materials or other information, including confidential and privileged documents, materials or other information subject to subsection (a), with the following:

(i) Federal, state and international regulatory agencies.

(ii) The National Association of Insurance Commissioners and its affiliates or subsidiaries.

(iii) Federal, state and international law enforcement authorities.

(iv) Third-party consultants, if the recipient agrees in writing to maintain the confidentiality and privileged status of the documents, materials or other information.

(2) May receive documents, materials or other information, including otherwise confidential and privileged documents, materials or other information, from the National Association of Insurance Commissioners, its affiliates or subsidiaries and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or other information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or other information.

(d) No delegation.--The sharing of information by the department under this chapter shall not constitute a delegation of regulatory authority or rulemaking. The department shall be solely responsible for the administration, execution and enforcement of this chapter.

(e) No waiver of privilege or confidentiality.--The sharing of confidential information with, to or by the department as authorized by this chapter shall not constitute a waiver of any applicable privilege or claim of confidentiality.

(f) Information with third parties.--Confidential information in the possession or control of the National Association of Insurance Commissioners or a third-party consultant as provided under this chapter shall:

(1) Be confidential and privileged.

(2) Be exempt from access under the Right-to-Know Law.

(3) Not be subject to subpoena.

(4) Not be subject to discovery or admissible as evidence in a private civil action.
40 Pa.C.S. § 5001 — PA Code / Title 40 / Chapter 50 / Section 5001
Scope of chapter.
Status: in_force

This chapter relates to electronic notice of insurance practices.
40 Pa.C.S. § 7141 — PA Code / Title 40 / Chapter 71 / Section 7141
Single-state company exemption.
Status: in_force

(a) Requirements.--A company may file a written request with the commissioner to exempt specific product forms or product lines issued by a domestic company from the requirements of sections 7125 (relating to valuation manual for policies issued on or after operative date of valuation manual) and 7126 (relating to requirements of principle-based valuation) if the company:

(1) Is licensed and doing business only in this Commonwealth.

(2) Computes reserves using assumptions and methods used prior to the operative date of the valuation manual in addition to any requirements established by the commissioner and promulgated by regulation.

(b) Written exemption.--An exemption under subsection (a) that is granted by the commissioner shall be in writing.

(c) Revocation.--The commissioner may revoke the exemption under subsection (a) if the conditions under subsection (a)(1) and (2) are no longer met after 180 days' written notice to the company regarding the conditions.

(d) Additional effects of exemption.--A company granted an exemption under subsection (a) shall also be exempt from any requirement under this chapter that is created by a reference to section 7125 or 7126 for the product forms or product lines exempted.
40 Pa.C.S. § 9307 — PA Code / Title 40 / Chapter 93 / Section 9307
Confidentiality and disclosure.
Status: in_force

(a) General rule.--Except as provided in this chapter, all working papers, recorded information, documents and copies of working papers, recorded information and documents produced by, obtained by or disclosed to the exchange authority or any other

person in the course of the exercise of the exchange authority's powers and duties under this chapter:

(1) shall be confidential;

(2) shall not be subject to subpoena;

(3) shall not be subject to the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law;

(4) shall not be subject to discovery or admissible in evidence in any private civil action; and

(5) may not be made public by the exchange authority or any other person.

(b) Personal health and financial information.--The exchange authority shall protect personally identifiable health and financial information in accordance with all applicable Federal and State laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936), the Health Information Technology for Economic and Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and implementing regulations.

(c) Information disclosure.--Subject to the confidentiality provisions of this section:

(1) Information shall be shared, as appropriate, for the purpose of determining and coordinating the eligibility of individuals for the exchange or any government program, including the Children's Health Insurance Program and medical assistance program, or for compliance with Federal law:

(i) Among the exchange authority and departments, including:

(A) The department.

(B) The Department of Aging.

(C) The Department of Drug and Alcohol Programs.

(D) The Department of Health.

(E) The Department of Human Services.

(F) The Department of Labor and Industry.

(G) The Department of Revenue.

(ii) Between the exchange authority and Federal agencies, including:

(A) The Centers for Medicare and Medicaid Services.

(B) The Treasury Department.

(2) Information may be disclosed:

(i) As necessary to comply with the audit requirements of section 9310 (relating to audits) and the reporting requirements of section 9311 (relating to reports), only in an aggregated and de-identified form.

(ii) In any circumstance, other than those described in paragraph (1) or subparagraph (i), only if the prior written consent of the company or person to which the information pertains has been obtained.

(d) Construction.--Nothing in this section shall be construed to prohibit the exchange authority from accessing the information necessary to carry out its responsibilities in accordance with law.
40 Pa.C.S. § 4303 — PA Code / Title 40 / Chapter 43 / Section 4303
Annual attestation.
Status: in_force

(a) Statement regarding MHPAEA compliance.--For the form for each health insurance policy offered, issued or renewed by an insurer, the insurer shall annually file with the department a statement attesting to the insurer's documented analyses of efforts to comply with MHPAEA and the Federal regulations relating to mental health and substance use disorder parity as of the date of the attestation.

(b) Statement regarding MHPAEA nonapplicability.--For the form for each insurance policy offered, issued or renewed by an insurer in this Commonwealth that is required to be filed but to which MHPAEA does not apply, the insurer shall annually file with the department a statement attesting to the nonapplicability of MHPAEA to the policy form.

(c) Filing.--Each attestation required under this section must be filed by April 30 of each year or with the form filing, whichever is earlier.
40 Pa.C.S. § 3907 — PA Code / Title 40 / Chapter 39 / Section 3907
Confidentiality.
Status: in_force

(a) General rule.--The CGAD-related information in the possession or control of the department that is produced by, obtained by or disclosed to the department or any other person under this chapter shall be privileged and given confidential treatment and shall not be:

(1) subject to discovery or admissible as evidence in a private civil action;

(2) subject to subpoena;

(3) subject to the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law; or

(4) made public by the department or any other person without the prior written consent of the insurer or insurance group to which it pertains, except as provided in subsection

(c).

(b) Private civil actions.--The commissioner, the department, a person who receives CGAD-related information while acting under the authority of the commissioner or department or a person with whom the CGAD-related information is shared under this chapter shall not be permitted or required to testify in a private civil action concerning confidential CGAD-related information.

(c) Use of CGAD-related information by department.--To assist in the performance of regulatory duties, the department may:

(1) Use CGAD-related information in furtherance of a regulatory or legal action brought pursuant to the department's official duties.

(2) Share CGAD-related information with the NAIC, regulatory or law enforcement officials of this Commonwealth or other jurisdictions, group supervisors, members of a supervisory college under section 1406.1 of the Insurance Company Law and third-party consultants under section 3906 (relating to third-party consultants) if, prior to receiving the CGAD-related information, the recipient demonstrates by written statement the necessary authority and intent to give confidential treatment to the CGAD-related information as required by this chapter.

(3) Receive and maintain as confidential CGAD-related information from the NAIC, regulatory or law enforcement officials of this Commonwealth or other jurisdictions, group supervisors and members of a supervisory college under section 1406.1 of The Insurance Company Law if the CGAD-related information is confidential by law in the jurisdiction from which it was received. CGAD-related information obtained under this paragraph shall be given confidential treatment, shall not be subject to subpoena and shall not be made public by the department, the commissioner or any other person.

(d) Written agreements.--The department shall enter into a written agreement with the NAIC or a third-party consultant governing the sharing and use of information provided under this chapter that includes all of the following:

(1) Specific procedures and protocols for maintaining the confidentiality and security of CGAD-related information.

(2) Procedures and protocols for sharing CGAD-related information only with regulators from other states in which the insurance group has domiciled insurers, including a written acknowledgment of the recipient's intent and legal authority to maintain the confidential and privileged status of the CGAD-related information.

(3) A provision specifying that ownership of the CGAD-related information shared remains with the department and that the use of the CGAD-related information is subject to the direction and approval of the department.

(4) A provision that prohibits storing CGAD-related information shared under this chapter in a permanent database after the underlying analysis is completed.

(5) A provision requiring prompt notice to the department and to the insurer or insurance group regarding a subpoena, request for disclosure or request for production of the insurer or insurance group's CGAD-related information in the possession of the NAIC or third-party consultant.

(6) A requirement to consent to intervention by an insurer or insurance group in a judicial or an administrative action in which the NAIC or third-party consultant may be required to disclose CGAD-related information or other confidential information about the insurer or insurance group that was shared under this chapter.

(e) No delegation.--The sharing of information by the department under this chapter does not constitute a delegation of regulatory authority or rulemaking. The department shall be solely responsible for the administration, execution and enforcement of this chapter.

(f) No waiver of privilege or confidentiality.--The sharing of CGAD-related information with, to or by the department as authorized by this chapter does not constitute a waiver of any applicable privilege or claim of confidentiality.

(g) Information with third parties.--CGAD-related information in the possession or control of the NAIC or a third-party consultant as provided under this chapter shall:

(1) be confidential and privileged;

(2) not be subject to the Right-to-Know Law;

(3) not be subject to subpoena; and

(4) not be subject to discovery or admissible as evidence in a private civil action. Cross References. Section 3907 is referred to in section 3911 of this title.
40 Pa.C.S. § 4301 — PA Code / Title 40 / Chapter 43 / Section 4301
Scope of chapter.
Status: in_force

This chapter relates to an attestation of compliance with Federal and State insurance laws regarding mental health and substance use disorder benefits.
40 Pa.C.S. § 3805 — PA Code / Title 40 / Chapter 38 / Section 3805
Coordination of benefits.
Status: in_force

If an insurer retroactively denies reimbursement for services as a result of coordination of benefits under the provisions of section 3804(4) (relating to exceptions to retroactive denial of reimbursement), the health care provider shall have 12 months from the date of the denial, unless the entity responsible for payment permits a longer time period, to submit a claim for reimbursement for the service to such entities.
40 Pa.C.S. § 4511 — PA Code / Title 40 / Chapter 45 / Section 4511
Differentiation between types of information.
Status: in_force

For purposes of determining what constitutes publicly available information, a licensee is deemed to have a reasonable basis to believe that information is lawfully made available to the general public if the licensee has taken steps to determine:

(1) that the information is of the type that is available to the general public; and

(2) whether a consumer is able to direct that the information not be made available to the general public and, if so, that the consumer has not done so.
40 Pa.C.S. § 9504 — PA Code / Title 40 / Chapter 95 / Section 9504
Reinsurance parameters.
Status: in_force

(a) Adoption of reinsurance terms.--The department shall, after consultation with all insurers then currently participating in the exchange, and not less than 60 days before final rates for health insurance policies are required to be submitted each year, determine and adopt the attachment point, reinsurance cap and coinsurance rate applicable to the reinsurance program for the following year.

(b) Parameters.--In determining the attachment point, reinsurance cap and coinsurance rate applicable to the reinsurance program for the following year, the department shall seek to:

(1) Manage the program within the amount of total program funding available to the department.

(2) With respect to the individual market:

(i) Mitigate the impact of high-cost claims on premium rates.

(ii) Stabilize or reduce premium rates.

(iii) Increase participation.

(c) Publication and notice.--The department shall transmit notice of the adopted attachment point, reinsurance cap and coinsurance rate to the Legislative Reference Bureau for publication in the Pennsylvania Bulletin and shall:

(1) Post notice on the department's publicly accessible Internet website.

(2) Electronically send notice to the chair and minority chair of the Banking and Insurance Committee of the Senate and the chair and minority chair of the Insurance Committee of the House of Representatives.

(3) Electronically send notice to each participating insurer via a contact person or electronic mailing address, as identified by the insurer.

(d) Limitation.--After the department adopts the attachment point, reinsurance cap and coinsurance rate for the next year, the department may not, before or during that benefit year, change the attachment point, reinsurance cap or coinsurance rate in a manner less favorable to the insurers participating in the exchange at the time of adoption. Cross References. Section 9504 is referred to in sections 9506, 9512 of this title.
40 Pa.C.S. § 9702 — PA Code / Title 40 / Chapter 97 / Section 9702
Enforcement.
Status: in_force

(a) General rule.--Upon satisfactory evidence of a violation of this part by an insurer or other person, one or more of the following penalties may be imposed at the commissioner's discretion:

(1) Suspension or revocation of the license of the insurer or other person.

(2) Refusal, for a period not to exceed one year, to issue a new license to the insurer or other person.

(3) A fine of not more than $5,000 for each violation.

(4) A fine of not more than $10,000 for each willful violation.

(b) Limitation.--

(1) Fines imposed against an individual insurer under this part may not exceed $500,000 in the aggregate during a single calendar year.

(2) Fines imposed against any other person under this part may not exceed $100,000 in the aggregate during a single calendar year.

(c) Additional remedies.--The enforcement remedies imposed under this subsection are in addition to any other remedies or penalties that may be imposed under any other applicable law of this Commonwealth, including:

(1) The act of July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance Practices Act. Violations of this part shall be deemed to be an unfair method of competition and an unfair or deceptive act or practice under the Unfair Insurance Practices Act.

(2) The act of June 25, 1997 (P.L.295, No.29), known as the Pennsylvania Health Care Insurance Portability Act.

(d) Administrative procedure.--The administrative provisions of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of Commonwealth agencies). A party against whom penalties are assessed in an administrative action may appeal to Commonwealth Court as provided in 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial review of Commonwealth agency action).
40 Pa.C.S. § 9703 — PA Code / Title 40 / Chapter 97 / Section 9703
Action by commissioner.
Status: in_force

(a) Sunset.--This part shall sunset immediately if any of the following occur:

(1) The Congress of the United States repeals or defunds those provisions of the Affordable Care Act integral to the exchange authority established under Chapter 93 (relating to State-based exchange) or the reinsurance program established under Chapter 95 (relating to reinsurance program).

(2) A court of the United States with competent jurisdiction invalidates the provisions of the Affordable Care Act integral to the duties of the exchange authority established under Chapter 93 or the reinsurance program established under Chapter 95.

(3) The Executive Branch of the United States repeals or defunds the provisions of the Affordable Care Act and its subsequent regulations integral to the duties of the exchange authority established under Chapter 93 or the reinsurance program established under Chapter 95.

(b) Notice.--If this part sunsets pursuant to subsection

(a), the commissioner shall transmit notice of that action to the Legislative Reference Bureau for publication in the Pennsylvania Bulletin. Cross References. Section 9703 is referred to in sections 9314, 9516 of this title. APPENDIX TO TITLE 40 INSURANCE ------- Supplementary Provisions of Amendatory Statutes ------- 1975, AUGUST 2, P.L.293, NO.94
40 Pa.C.S. § 6104 — PA Code / Title 40 / Chapter 61 / Section 6104
Uncertified plans prohibited.
Status: in_force

It shall be unlawful for any person, other than a hospital plan corporation holding a certificate of authority under this chapter, to establish, maintain or operate a nonprofit hospital plan in this Commonwealth.
40 Pa.C.S. § 4707 — PA Code / Title 40 / Chapter 47 / Section 4707
Sales practices for pet insurance policies.
Status: in_force

A pet insurer:

(1) May not make any false, deceptive or misleading statement in the advertisement of a pet insurance policy.

(2) Shall disclose in any advertisement regarding a pet insurance policy a statement as to whether the pet insurer will reduce coverage or increase premiums based on:

(i) the insured's claim history;

(ii) the species or breed of the pet covered under the pet insurance policy;

(iii) the age of the pet covered under the pet insurance policy; or

(iv) a change in the geographic location of the insured.
40 Pa.C.S. § 7116 — PA Code / Title 40 / Chapter 71 / Section 7116
Computation of minimum standard for annuities.
Status: in_force

(a) Computation generally.--Except as provided in section 7117 (relating to computation of minimum standard by calendar year of issue), the minimum standard of valuation for individual annuity and pure endowment contracts issued on or after the operative date of section 301(c)(1)(B) of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of 1921, and for annuities and pure endowments purchased on or after that operative date under group annuity and pure endowment contracts shall be the commissioner's reserve valuation methods established under sections 7118 (relating to reserve valuation method for life insurance and endowment benefits) and 7119 (relating to reserve valuation method for annuity and pure endowment benefits) and the following:

(1) For individual annuity and pure endowment contracts issued prior to January 1, 1979, excluding disability and accidental death benefits in the contracts, the 1971 Individual Annuity Mortality Table or any modification of the table approved by the commissioner, and 6% interest for single premium immediate annuity contracts and 4% interest for all other individual annuity and pure endowment contracts.

(2) For individual single premium immediate annuity contracts issued on or after January 1, 1979, excluding disability and accidental death benefits in the contracts, the 1971 Individual Annuity Mortality Table or any individual annuity mortality table that is adopted after 1980 by NAIC and approved by regulation for use in determining the minimum standard of valuation for the contracts, or any modification of the tables approved by the commissioner, and 7.5% interest or a higher rate of interest as may be approved by the commissioner.

(3) For individual annuity and pure endowment contracts issued on or after January 1, 1979, other than single premium immediate annuity contracts and excluding disability and accidental death benefits in the contracts, the 1971 Individual Annuity Mortality Table or any individual annuity mortality table that is adopted after 1980 by NAIC and approved by regulation for use in determining the minimum

standard of valuation for the contracts, or any modification of the tables approved by the commissioner, and 5.5% interest for single premium deferred annuity and pure endowment contracts and 4.5% interest for all other individual annuity and pure endowment contracts or a higher rate of interest as may be approved by the commissioner.

(4) For annuities and pure endowments purchased prior to January 1, 1979, under group annuity and pure endowment contracts and excluding disability and accidental death benefits purchased under the contracts, the 1971 Group Annuity Mortality Table or any modification of the table approved by the commissioner, and 6% interest.

(5) For annuities and pure endowments purchased on or after January 1, 1979, under group annuity and pure endowment contracts and excluding disability and accidental death benefits purchased under the contracts, the 1971 Group Annuity Mortality Table or any group annuity mortality table that is adopted after 1980 by NAIC and approved by regulation for use in determining the minimum standard of valuation for annuities and pure endowments, or any modification of the tables approved by the commissioner, and 7.5% interest or a higher rate of interest as may be approved by the commissioner.

(b) Operative date.--After June 23, 1976, a company may file with the commissioner a written notice of its election to comply with the provisions of this section after a specified date before January 1, 1979, which shall be the operative date of this section for that company. A company may elect a different operative date for individual annuity and pure endowment contracts from that elected for group annuity and pure endowment contracts. If a company makes no election, the operative date of this section for that company shall be January 1, 1979. Cross References. Section 7116 is referred to in sections 7103, 7111, 7115 of this title.
40 Pa.C.S. § 6124 — PA Code / Title 40 / Chapter 61 / Section 6124
Rates and contracts.
Status: in_force

(a) General rule.--The rates charged to subscribers by hospital plan corporations, all rates of payments to hospitals made by such corporations pursuant to the contracts provided for in this chapter, all acquisition costs in connection with the solicitation of subscribers to such hospital plans, the reserves to be maintained by such corporations, the certificates issued by such corporations representing their agreements with subscribers, and any and all contracts entered into by any such corporation with any hospital, shall, at all times, be subject to the prior approval of the department.

(b) Procedure.--Every application for such approval shall be made to the department in writing and shall be subject to the provisions of subsections (c) through (f) of section 6102 of this title (relating to certification of hospital plan corporations) except that the department may substitute publication in the Pennsylvania Bulletin of notice of reasonable opportunity to submit written comments for publication of opportunity for hearing in any case where the right to an oral hearing is not conferred by the Constitution of the United States or the Constitution of Pennsylvania. Within 60 days after the filing of the application the department shall approve or refuse such application.

(c) Maintenance of contractual relationships.--

(1) Declaration of necessity.--It is hereby found that many subscribers to nonprofit hospital plans make payments over long periods of time prior to becoming entitled to benefits under such a plan and that it is important in the public interest that the reasonable expectations of such subscribers as to coverage should be fulfilled if possible. It is hereby declared to be essential for the maintenance of the health of the residents of this Commonwealth that subscribers to nonprofit hospital plans be assured receipt of the hospitalization and related health benefits prepaid by them through payment of the rates approved under this chapter and charged by a hospital plan corporation and that to accomplish this essential purpose termination of contracts between hospital plan corporations and hospitals entered into pursuant to section 6121 (relating to eligible

hospitals) and this section be subject to prior approval by the department as provided in this subsection.

(2) Notification period.--No contract between a hospital plan corporation and any hospital providing for the rendering of hospitalization to subscribers to the hospital plan shall be terminated unless the party seeking such termination gives 90 days advance written notice to the other party to the contract and to the department of the proposed termination.

(3) Hearing period.--Whenever a termination subject to paragraph (2) involves contracts with hospitals having more than 5% of the beds in the area served by a hospital plan corporation, the department shall hold public hearings on at least 15 days notice for the purpose of investigating the reasons for the termination. Pending completion of said investigation by the department, termination of the hospital contracts shall be suspended for a period not to exceed six months from the expiration of the period provided for in paragraph (2). All terms and conditions of the contract between the hospital plan corporation and the hospital or hospitals shall continue in full force and effect during said investigation by the department. Based on the record made during the hearings, the department shall make specific findings as to the facts of the dispute and shall either approve termination of the contracts or recommend such terms for continuation of the contract as are in the public interest, based upon the facts, the right of a hospital to be paid its costs for hospitalization services to subscribers and the need of subscribers for efficient, reliable hospitalization at a reasonable cost.

(4) Negotiation period.--If the department recommends terms for continuation of the contract, the hospital plan corporation and the hospitals involved shall renew their negotiations in order to determine whether a new agreement can be reached substantially on the basis of the terms for continuation recommended by the department and pending such negotiations, the termination of the hospital contracts shall be suspended for a further period not to exceed 90 days from the date of the decision of the department. If the hospital plan corporation and the hospitals are unable to consummate a new contract within said further period of 90 days, they shall so advise the department. The department shall in that event approve termination of the contracts effective at the end of a further period of 30 days and shall prescribe the form and extent of notice which the hospital plan corporation shall use in advising its subscribers that hospitalization in the hospitals involved is not covered by a contract between the hospital plan corporation and such hospitals.

(5) Retroactivity.--Upon the settlement of any dispute between a hospital plan corporation and any hospital pursuant to paragraphs (2) and (4), the terms and conditions of any new contract shall be retroactive to the date of expiration of the contract previously in effect between the parties. (Aug. 2, 1975, P.L.293, No.94, eff. imd.) 1996 Partial Repeal. Section 14 of Act 159 of 1996, known as the Accident and Health Filing Reform Act, provided that subsec. (a) is repealed insofar as it provides for the approval of rates and contracts. 1975 Amendment. Act 94 added subsec. (c). See sections 2 and 3 of Act 94 of 1975 in the appendix to this title for special provisions relating to applicability and effective date and retroactivity.

References in Text. Section 14 of Act 159 of 1996, known as the Accident and Health Filing Reform Act, was renumbered 5101 by the act of December 22, 2011, P.L.614, No.134.
40 Pa.C.S. § 9306 — PA Code / Title 40 / Chapter 93 / Section 9306
Limitations.
Status: in_force

Except as expressly provided in this chapter, nothing in this chapter shall be construed to limit or supersede the authority vested in a Commonwealth agency, including:

(1) The Insurance Department, including the department's authority to regulate the business of insurance within this Commonwealth, including health insurance policies whether offered on or off the exchange.

(2) The Department of Human Services, including with respect to the medical assistance program or the Children's Health Insurance Program.

(3) The Department of Health.

(4) The Office of Attorney General.
40 Pa.C.S. § 101 — PA Code / Title 40 / Chapter 1 / Section 101
Definitions.
Status: in_force

Subject to additional definitions contained in subsequent provisions of this title which are applicable to specific parts, articles, chapters or other provisions of this title, the

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

"Beneficial society." A corporation subject to regulation under the act of June 4, 1937 (P.L.1643, No.342).

"Certificate of authority." An instrument in writing issued by the department authorizing an insurer or proposed insurer to engage in the business of insurance, or some specified line, branch or part thereof, in this Commonwealth.

"Corporation not-for-profit." A corporation not-for-profit as defined in Title 15 (relating to corporations and unincorporated associations).

"Department." The Insurance Department of the Commonwealth.

"Foreign." Not incorporated or organized under the laws of this Commonwealth.

"Uncertificated." Not holding an unsuspended or unrevoked certificate of authority authorizing the relevant line, branch or part of the business of insurance.
40 Pa.C.S. § 3509 — PA Code / Title 40 / Chapter 35 / Section 3509
Conflict of interest.
Status: in_force

(a) Compensation.--A director, officer, agent or employee of the attorney or reciprocal insurer may not receive a fee, commission or other valuable consideration, other than his usual regular salary or compensation, for aiding, promoting or assisting in a conversion under this chapter except as provided for in the plan approved by the commissioner. This subsection does not prohibit the payment of reasonable fees and

compensation to counsel, accountants and actuaries for services performed in the independent practice of their professions, even if the counsel, accountant or actuary is also a director or officer of the attorney or the reciprocal insurer.

(b) Stock benefit plan.--For a period of two years after the effective date of the conversion, a stock company may not implement a non-tax-qualified stock benefit plan unless the plan is approved by a majority of votes eligible to be cast at a meeting of shareholders held not less than six months after the effective date of the conversion.

(c) Costs and expenses.--The costs and expenses connected with a plan of conversion shall be paid for or reimbursed by the reciprocal insurer or the stock company. If the plan provides for participation by another corporation or stock company in the plan under section 3503(a)(3)(ii) (relating to contents of plan of conversion), the corporation or stock company may pay for or reimburse all or a portion of the costs and expenses connected with the plan. Cross References. Section 3509 is referred to in section 3503 of this title.
40 Pa.C.S. § 3513 — PA Code / Title 40 / Chapter 35 / Section 3513
Rules and regulations.
Status: in_force

The commissioner may promulgate rules and regulations to administer and enforce this chapter.
40 Pa.C.S. § 7137 — PA Code / Title 40 / Chapter 71 / Section 7137
Limited exceptions.
Status: in_force

Notwithstanding section 7132 (relating to general rule for confidential information), confidential information as defined in section 7131(1) and (4) (relating to confidential information defined):

(1) May be shared with the Actuarial Board for Counseling and Discipline if the information is required for the purpose of professional disciplinary proceedings and the Actuarial Board for Counseling and Discipline recipient agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of the documents, materials, data and other information in the same manner and to the same extent as required for the commissioner.

(2) May be subject to subpoena for the purpose of defending an action seeking damages from the actuary submitting the related memorandum in support of an opinion submitted under section 7113 (relating to actuarial opinion of reserves prior to operative date of valuation manual) or 7114 (relating to actuarial opinion of reserves on or after operative date of valuation manual) or a principle-based valuation report developed under section 7126(b)(3) (relating to requirements of principle-based valuation) by reason of an action required by this chapter or regulations promulgated under this chapter.

(3) May be released by the commissioner with the written consent of the company.

(4) Is no longer confidential once any portion of a memorandum in support of an opinion submitted under section 7113 or 7114 or a principle-based valuation report developed under section 7126(b)(3) is:

(i) cited by the company in its marketing materials;

(ii) publicly released to a governmental agency other than a State insurance department; or

(iii) released by the company to the news media.
40 Pa.C.S. § 4532 — PA Code / Title 40 / Chapter 45 / Section 4532
Exemptions.
Status: in_force

(a) Licensee criteria.--A licensee meeting any of the following criteria shall be exempt from sections 4512 (relating to risk assessment), 4513 (relating to information security program), 4514 (relating to corporate oversight), 4515 (relating to oversight of third-party service provider arrangements) and 4516 (relating to certification):

(1) The licensee has fewer than 10 employees.

(2) The licensee has less than $5,000,000 in gross revenue.

(3) The licensee has less than $10,000,000 in year-end total assets.

(b) Federal law.--A licensee that is subject to and governed by the privacy, security and breach notification rules issued by the United States Department of Health and Human Services under 45 CFR Pts. 160 (relating to general administrative requirements) and 164 (relating to security and privacy), established in accordance with the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936) and the Health Information Technology for Economic and Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496), and which maintains nonpublic information in the same manner as protected health information shall be deemed to comply with the requirements of this chapter except for the notification requirements of section 4518(a), (b) and (c) (relating to notification of cybersecurity event).

(c) Employees, agents, representatives and designees.--An employee, agent, representative or designee of a licensee, who is also a licensee, shall be exempt from sections 4512, 4513, 4514, 4515 and 4516 and need not develop its own information security program to the extent that the employee, agent, representative or designee is covered by the information security program of the other licensee.

(d) Compliance.--If a licensee ceases to qualify for an exemption under this section, the licensee shall have 180 days to comply with this chapter.
40 Pa.C.S. § 4534 — PA Code / Title 40 / Chapter 45 / Section 4534
Construction with other laws.
Status: in_force

(a) Private cause of action.--Nothing in this chapter shall be construed to:

(1) Create or imply a private cause of action for a violation of this chapter.

(2) Curtail a private cause of action that otherwise exists in the absence of this chapter.

(b) Exclusive standards.--Notwithstanding any other provision of law, this chapter shall establish the exclusive State standards applicable to licensees for data security, the licensees' investigation of a cybersecurity event and notification to the commissioner.
40 Pa.C.S. § 2 — PA Code / Title 40 / Chapter 2 / Section 2
Applicability.
Status: in_force

The procedures established by this act shall apply to:

(1) any termination of contracts between hospital plan corporations and hospitals hereafter occurring; and

(2) any contracts between hospital plan corporations and hospitals under which subscribers received prepaid benefits on or after June 30, 1974 if such hospital plan corporations and hospitals were governed by contracts subject to 40 Pa.C.S. Chap. 61 (relating to hospital plan corporations) or corresponding provisions of law on June 30, 1964 and substantially continuously thereafter to and including June 30, 1974. Such contracts, if terminated, shall be reinstated as of their original termination and may be terminated hereafter only pursuant to the provisions of this act.

Explanatory Note. Act 94 added section 6124(c) of Title 40.
40 Pa.C.S. § 5011 — PA Code / Title 40 / Chapter 50 / Section 5011
Construction.
Status: in_force

(a) Applicability.--Nothing in this chapter shall apply to self-insured health benefit plans subject to ERISA or exempted from ERISA under section 4(b) of ERISA.

(b) Content and timing of notices.--Nothing in this chapter shall be construed to affect or change the time or content of a disclosure or document required to be provided to a plan sponsor under Federal or State law.
40 Pa.C.S. § 9513 — PA Code / Title 40 / Chapter 95 / Section 9513
Confidentiality and information disclosure.
Status: in_force

(a) General rule.--Except as provided for in this section, all working papers, recorded information, documents and copies of working papers, recorded information and documents produced by, obtained by or disclosed to the department or any other person in the course of exercising the department's powers and duties under this chapter:

(1) shall be confidential;

(2) shall not be subject to subpoena;

(3) shall not be subject to the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law;

(4) shall not be subject to discovery or admissible in evidence in any private civil action; and

(5) may not be made public by the department or any other person.

(b) Personal health and financial information.--The department shall protect personally identifiable health and financial information in accordance with Federal and State laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936), the Health Information Technology for Economic and Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and implementing regulations.

(c) Information disclosure.--Subject to the confidentiality provisions of this section:

(1) Information shall be shared as follows:

(i) Between the department and the Centers for Medicare and Medicaid Services for purposes of compliance with the Federal acts.

(ii) Between the department and each insurer participating in the reinsurance program.

(iii) Between the department and the exchange authority.

(2) Information may be disclosed as follows:

(i) As necessary to comply with the audit requirements of section 9508 (relating to annual audit) and the reporting requirements of section 9509 (relating to annual report of operations), only in an aggregated and de-identified form.

(ii) In any circumstance other than as described in paragraph (1) or subparagraph (i), only if the prior written consent of the company or person to which the information pertains is obtained.

(d) Construction.--Nothing in this section shall be construed to prohibit the department from accessing the information reasonably required to carry out its responsibilities in accordance with law.
40 Pa.C.S. § 4536 — PA Code / Title 40 / Chapter 45 / Section 4536
Initial compliance.
Status: in_force

Licensees shall have one year from the effective date of this section to implement sections 4512 (relating to risk

assessment), 4513 (relating to information security program), 4514 (relating to corporate oversight) and 4516 (relating to certification) and two years from the effective date of this section to implement section 4515 (relating to oversight of third-party service provider arrangements).
40 Pa.C.S. § 7104 — PA Code / Title 40 / Chapter 71 / Section 7104
Notice regarding operative date of valuation manual.
Status: in_force

Upon the occurrence of the last occurring event under the definition of "operative date of the valuation manual" in section 7102 (relating to definitions), the commissioner shall issue a notice regarding the operative date of the valuation manual to be published in the Pennsylvania Bulletin and on the department's publicly accessible Internet website.
40 Pa.C.S. § 9516 — PA Code / Title 40 / Chapter 95 / Section 9516
Expiration.
Status: in_force

Upon publication of the notice under section 9703(b) (relating to action by commissioner), the department shall

initiate steps to cease operation of the reinsurance program and shall cease operation of the reinsurance program no later than 15 months after publication of the notice.
40 Pa.C.S. § 9501 — PA Code / Title 40 / Chapter 95 / Section 9501
Application.
Status: in_force

(a) Application.--The department is authorized to apply to the United States Secretary of Health and Human Services under section 1332 of the Affordable Care Act (Public Law 111-148, 42 U.S.C. § 18052) for a state innovation waiver to:

(1) Waive any applicable provisions of the Affordable Care Act with respect to health insurance coverage in this Commonwealth.

(2) Establish a reinsurance program in accordance with an approved waiver.

(3) Maximize Federal funding for the reinsurance program for plan years beginning on or after implementation of the program.

(b) Public review.--On or before 180 days after the effective date of this section, the department shall make a draft application available for a 30-day public review and comment period. The department shall consider any comments in its final submitted application.

(c) Amendment.--The department may amend the waiver application as necessary to carry out the provisions of this chapter.

(d) Notification.--The department shall notify the chair and minority chair of the Appropriations Committee of the Senate, the chair and minority chair of the Appropriations Committee of the House of Representatives, the chair and minority chair of the Banking and Insurance Committee of the

Senate and the chair and minority chair of the Insurance Committee of the House of Representatives promptly of any amendment to the waiver application and of any Federal actions regarding the waiver application. Cross References. Section 9501 is referred to in sections 9502, 9512 of this title.
40 Pa.C.S. § 9507 — PA Code / Title 40 / Chapter 95 / Section 9507
Not an entitlement.
Status: in_force

(a) No entitlement.--The provision of reinsurance program money or benefits accrued through the Reinsurance Fund may not

constitute an entitlement derived from the Commonwealth or a claim on any other money of the Commonwealth.

(b) Contingency with respect to Federal money.--Notwithstanding any provision of this chapter, the department shall have no responsibility to pay reinsurance amounts that would be payable out of Federal money if the Federal Government does not transmit sufficient money for the Reinsurance Fund to fully recompense those actions.
40 Pa.C.S. § 4515 — PA Code / Title 40 / Chapter 45 / Section 4515
Oversight of third-party service provider arrangements.
Status: in_force

A licensee shall:

(1) Exercise due diligence in selecting its third-party service provider.

(2) Require a third-party service provider to implement appropriate administrative, technical and physical measures to protect and secure the information systems and nonpublic

information that are accessible to, or held by, the third-party service provider. Cross References. Section 4515 is referred to in sections 4514, 4516, 4521, 4532, 4536 of this title.
40 Pa.C.S. § 9305 — PA Code / Title 40 / Chapter 93 / Section 9305
Powers and duties of exchange authority.
Status: in_force

(a) Corporate operations.--The exchange authority shall exercise all powers and duties necessary and appropriate to carry out its purpose, including the following:

(1) Adopt bylaws.

(2) Employ staff.

(3) Make, execute and deliver contracts.

(4) Apply for, solicit and receive money from any source consistent with the purpose of this chapter.

(5) Establish priorities for, allocate and disburse money received.

(6) Submit annually to the Appropriations Committee of the Senate and the Appropriations Committee of the House of Representatives, at the same time the exchange authority submits its budget to the Governor, a copy of its budget request and all subsequently revised budget requests for the ensuing fiscal year. The budget shall include the amounts to be appropriated out of the fund established under section 9312 (relating to exchange fund) necessary to administer the provisions of this chapter and the conveyance of money to the Reinsurance Fund established under section 9510 (relating to Reinsurance Fund).

(7) Establish travel reimbursement policies for the exchange authority, its board and its advisory council.

(8) Coordinate with the appropriate Federal and State agencies to seek waivers from statutory or regulatory requirements as necessary to carry out the purposes of this chapter.

(9) Enter into other arrangements, including, without limitation, interagency agreements with Federal agencies and Commonwealth agencies or other states' agencies as may be necessary or appropriate to carry out the duties of the exchange authority.

(10) Give reasonable public notice of any policies and procedures the exchange authority may implement to accomplish the operation of the exchange authority.

(11) Perform other operational activities necessary or appropriate to further the purposes of this chapter.

(12) The board shall consider the advice of the advisory council provided under section 9304(g) (relating to meetings and operation).

(b) Programmatic duties.--The exchange authority shall perform all duties necessary or appropriate to advance its purpose, including the following:

(1) Educate consumers, including through outreach, a navigator program and postenrollment support.

(2) Assist individuals to access income-based assistance for which they may be eligible, including premium tax credits, cost-sharing reductions and government programs.

(3) Take into consideration the need for consumer choice in rural, urban and suburban areas across the Commonwealth.

(4) Assess and collect fees from on-exchange insurers to support the operation of the exchange under this chapter and the reinsurance program established under section 9502(b) (relating to implementation of waiver and establishment of reinsurance program), except that the exchange authority may not assess or collect any form of obligation other than an exchange user fee on total monthly premiums for on-exchange policies and unless approved by unanimous consent of the board, the fee may not exceed 3% of total monthly premiums for on-exchange policies. In no case may the fee exceed 3.5%.

(5) Disburse receipted fees, including to benefit the reinsurance program established under section 9502(b).

(c) Enforcement and State sovereignty.--The exchange authority shall ensure that the exchange complies with the Federal acts and rules and regulations that may be imposed by the Federal Government pursuant to the Federal acts in a manner that maintains State sovereignty over the health insurance market in this Commonwealth. Enforcement responsibilities shall be delegated to the appropriate State agency and shall be sufficient to prevent a determination by the United States Secretary of Health and Human Services that the Commonwealth has failed to substantially enforce any provision of the Federal acts. Cross References. Section 9305 is referred to in section 9302 of this title.
40 Pa.C.S. § 7135 — PA Code / Title 40 / Chapter 71 / Section 7135
Agreements.
Status: in_force

The department may enter into agreements governing sharing and use of confidential information consistent with this subchapter.
40 Pa.C.S. § 6324 — PA Code / Title 40 / Chapter 63 / Section 6324
Rights of health service doctors.
Status: in_force

(a) Admission to plan.--Every health service doctor practicing within the area covered by any professional health service corporation shall have the right, on complying with such regulations as the corporation may make with the approval of the Department of Health, to register with such corporation for such general or special professional health services as he may be licensed to practice, within that area, but the corporation may, with the approval of the Department of Health, refuse to place the name of any health service doctor on its register. Any professional health service corporation may, with the approval of the Department of Health, remove from its register the name of any health service doctor after due notice and opportunity for hearing for cause satisfactory to the corporation. Nothing in this section shall be construed to limit the discretion of a professional health service corporation to determine the classes or kinds of services that will be covered under its contracts.

(b) Freedom from control.--Subject to the provisions of section 6322(e) of this title (relating to liability of corporation limited), a professional health service corporation shall impose no restrictions on the health service doctors who administer to its subscribers, as to methods of diagnosis or treatment. The relation between a subscriber, or any of his dependents, and the health service doctor shall be identical with the relation that ordinarily exists in the community between a health service doctor and his patient. Subject to the provisions of subsection (a) of this section, no person shall be permitted to interfere with the choice or selection by a patient of his health service doctor after that choice or selection has been made by an adult of sound mind.

(c) Disputes.--All matters, disputes, or controversies relating to the professional health services rendered by the

health service doctors, or any questions involving professional ethics, shall be considered and determined only by health service doctors as selected in a manner prescribed in the bylaws of the professional health service corporation. (Oct. 9, 2008, P.L.1393, No.108, eff. 120 days) 2008 Amendment. Act 108 amended subsec. (a).
40 Pa.C.S. § 6121 — PA Code / Title 40 / Chapter 61 / Section 6121
Eligible hospitals.
Status: in_force

Any hospital plan corporation may enter into contracts for the rendering of hospitalization to any of its subscribers only with hospitals operated by the Commonwealth, or its agencies, or by political subdivisions, or by corporations organized under the laws of this Commonwealth for hospital purposes, or with such other hospitals as are approved by the Department of Public Welfare. References in Text. The Department of Public Welfare, referred to in this section, was redesignated as the Department of Human Services by Act 132 of 2014. Cross References. Section 6121 is referred to in section 6124 of this title.
40 Pa.C.S. § 4535 — PA Code / Title 40 / Chapter 45 / Section 4535
Prevention or abrogation of agreements.
Status: in_force

Nothing in this chapter shall prevent or abrogate an agreement between a licensee and another licensee, a third-party service provider or any other party to fulfill any of the investigation requirements imposed under section 4517 (relating to investigation of cybersecurity event) or notice requirements imposed under section 4518 (relating to notification of cybersecurity event).
40 Pa.C.S. § 4003 — PA Code / Title 40 / Chapter 40 / Section 4003
Denial of coverage.
Status: in_force

(a) Partial supply.--A health insurance policy providing prescription drug coverage may not deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensing is for a partial supply if the prescriber or pharmacist determines the fill or refill to be in the best interest of the patient and

the patient requests or agrees to a partial supply for the purpose of medication synchronization.

(b) Denial codes.--The health insurance policy shall accept early refill and partial supply requests for maintenance medications dispensed for the purpose of medication synchronization using the submission clarification and message codes as adopted by the National Council for Prescription Drug Programs or alternative codes provided by the health insurance policy.

(c) Compliance.--Nothing in this chapter may prohibit a health insurance policy from using other methods to comply with this chapter.
40 Pa.C.S. § 6306 — PA Code / Title 40 / Chapter 63 / Section 6306
Standards concerning incorporators.
Status: in_force

No certificate of authority shall be issued to a professional health service corporation unless all of its incorporators were residents of this Commonwealth and citizens of the United States. (Apr. 28, 1978, P.L.202, No.53) 1978 Repeal. Act 53 repealed section 6306 in part, effective February 13, 1973. The repealed provisions have been deleted from the text.
40 Pa.C.S. § 3511 — PA Code / Title 40 / Chapter 35 / Section 3511
Limitation on actions.
Status: in_force

An action challenging the validity of or arising out of acts taken or proposed to be taken under this chapter shall be commenced no later than 30 days after the later of the approval of the plan by the commissioner or the deemed approval of the plan by a vote of the eligible subscribers.
40 Pa.C.S. § 7143 — PA Code / Title 40 / Chapter 71 / Section 7143
Adoption of exemption standards of NAIC Valuation Manual.
Status: in_force

(a) Findings and declarations.--The General Assembly finds and declares that the work of NAIC and the participation of the commissioner in NAIC are essential to the general implementation of this chapter.

(b) Standards.--To effectuate the decision as to whether to exempt certain policies, certificates or products of a particular company from certain provisions of the NAIC Valuation Manual, the commissioner shall determine, on an annual basis, whether to adopt the standards for exemption specified in the most recent version of the NAIC Valuation Manual by submitting a statement of policy to the Legislative Reference Bureau for publication in the next available issue of the Pennsylvania Bulletin.

(c) Statement of policy.--A statement of policy issued under subsection (b) shall be exempt from the following:

(1) Section 205 of the act of July 31, 1968 (P.L.769, No.240), referred to as the Commonwealth Documents Law.

(2) Section 204(b) and 301(10) of the act of October 15, 1980 (P.L.950, No.164), known as the Commonwealth Attorneys Act.

(3) The act of June 25, 1982 (P.L.633, No.181), known as the Regulatory Review Act.

(d) Construction.--Nothing in this section shall affect any other provision in this chapter or apply to any action taken by the department prior to the effective date of this section. (June 14, 2023, P.L.4, No.2, eff. imd.)

2023 Amendment. Act 2 added section 7143.
40 Pa.C.S. § 9503 — PA Code / Title 40 / Chapter 95 / Section 9503
Administration and operation of reinsurance program.
Status: in_force

(a) General rule.--The department shall take all actions necessary to administer the approved reinsurance program in a manner consistent with applicable Federal and State law.

(b) Functions.--The department shall perform all functions necessary and appropriate to carry out the operation of the reinsurance program and to effectuate the purposes for which the reinsurance program is organized, in accordance with the approved waiver. The functions include:

(1) Establishing procedures for and performing administrative and accounting operations of the reinsurance program.

(2) Seeking and receiving funding for the reinsurance program and to maximize Federal funding for the reinsurance program, including from:

(i) The exchange authority.

(ii) Federal funding that is or becomes available to states to support administration and implementation of state-based reinsurance programs.

(iii) Other available sources.

(3) Collecting data submissions and reinsurance payment requests by eligible insurers.

(4) Making reinsurance payments to eligible insurers.

(5) Resolving disputes related to the amount of reinsurance payments.

(6) Suing or being sued, including taking any legal action necessary or proper for the recovery of money for reinsurance payments.

(7) Submitting invoices or other requests for money as may be necessary and appropriate under the innovation waiver.

(c) Delegation.--Except as prohibited by applicable Federal law and regulation, and as may be necessary or appropriate to carry out department duties, the department may administer the reinsurance program directly or through:

(1) Other Federal agencies, Commonwealth agencies or other states' agencies.

(2) Contracted persons or entities, including with legal, actuarial, economic, third-party administrator or other persons or entities, as the department deems appropriate, to provide consultation services and technical assistance in operating the reinsurance program. Contracted persons or entities shall submit regular reports to the department regarding the person's or entity's performance, the frequency, content and form of which shall be determined by the department.

(d) Coordination with exchange authority.--The department shall coordinate with the exchange authority as may be necessary to fund and operate the reinsurance program.
40 Pa.C.S. § 7123 — PA Code / Title 40 / Chapter 71 / Section 7123
Reserve calculation for indeterminate premium plans.
Status: in_force

(a) Applicability.--This section shall apply to either of the following:

(1) A plan of life insurance that provides for future premium determination, the amounts of which are to be determined by the insurance company based on then estimates of future experience.

(2) A plan of life insurance or annuity that is of a nature that the minimum reserves cannot be determined by the methods described in any of the following:

(i) Section 7118 (relating to reserve valuation method for life insurance and endowment benefits).

(ii) Section 7119 (relating to reserve valuation method for annuity and pure endowment benefits).

(iii) Section 7122 (relating to reserve calculation for valuation net premium exceeding gross premium charged).

(b) Nature and calculation of reserves.--The reserves that are held under a plan under this section shall be:

(1) Appropriate in relation to the benefits and the pattern of premiums for the plan.

(2) Computed by a method that is consistent with the principles of this chapter, as determined by regulation. Cross References. Section 7123 is referred to in sections 7103, 7120 of this title.
40 Pa.C.S. § 4708 — PA Code / Title 40 / Chapter 47 / Section 4708
Sales practices for wellness programs.
Status: in_force

(a) Prohibitions.--A pet insurer or insurance producer may not characterize a wellness program as pet insurance.

(b) Conditions.--The sale, solicitation or negotiation of a wellness program by a pet insurer or insurance producer shall be in accordance with the following requirements:

(1) The purchase of the wellness program shall not be required for the purchase of a pet insurance policy.

(2) The costs of the wellness program shall be separate and identifiable from any pet insurance policy sold by a pet insurer or insurance producer.

(3) The terms and conditions of the wellness program must be separate from any pet insurance policy sold by a pet insurer or insurance producer.

(4) The products or coverages available through the wellness program shall not duplicate products or coverages available through the pet insurance policy.

(5) The advertising of the wellness program shall not be misleading and shall be in accordance with this subsection.

(6) The insured or prospective insured shall be provided a notice containing the following information in 12-point boldface type:

(i) A statement that a wellness program is not insurance.

(ii) The address and customer service telephone number of the pet insurer or insurance producer or broker of record.

(iii) The department's mailing address, toll-free telephone number and website address.

(c) Construction.--If a pet insurance policy contains coverage for benefits described as "wellness benefits," the benefits shall be considered insurance for purposes of this chapter.
40 Pa.C.S. § 7151 — PA Code / Title 40 / Chapter 71 / Section 7151
Effect on The Insurance Company Law of 1921.
Status: in_force

(a) Fraternal benefit organizations.--The following shall apply:

(1) Section 2451(b) of The Insurance Company Law of 1921 shall apply to the minimum reserves for certificates issued after February 11, 1994 and prior to the effective date of this chapter.

(2) The minimum reserves for certificates issued on or after the effective date of this chapter shall be governed by this chapter.

(b) Standard nonforfeiture law for life insurance.--Notwithstanding any provision of The Insurance Company Law of 1921:

(1) For policies issued prior to the operative date of the valuation manual, any commissioners standard ordinary mortality table that was adopted after 1980 by NAIC and is approved by regulation for use in determining the minimum nonforfeiture standard may be substituted for the Commissioners 1980 Standard Ordinary Mortality Table with or without Ten-Year Select Mortality Factors or for the Commissioners 1980 Extended Term Insurance Table.

(2) For policies issued on or after the operative date of the valuation manual, the valuation manual shall provide the commissioners standard mortality table for use in determining the minimum nonforfeiture standard that may be substituted for the Commissioners 1980 Standard Ordinary Mortality Table with or without Ten-Year Select Mortality Factors or for the Commissioners 1980 Extended Term Insurance Table. If the commissioner approves by regulation any commissioners standard ordinary mortality table adopted by NAIC for use in determining the minimum nonforfeiture standard for policies issued on or after the operative date of the valuation manual, that minimum nonforfeiture standard shall supersede the minimum nonforfeiture standard provided by the valuation manual.

(3) For policies issued prior to the operative date of the valuation manual, any commissioners standard industrial mortality table that was adopted after 1980 by NAIC and that is approved by regulation for use in determining the minimum nonforfeiture standard may be substituted for the Commissioners 1961 Standard Industrial Mortality Table or the Commissioners 1961 Industrial Extended Term Insurance Table.

(4) For policies issued on or after the operative date of the valuation manual, the valuation manual shall provide the commissioners standard mortality table for use in determining the minimum nonforfeiture standard that may be substituted for the Commissioners 1961 Standard Industrial Mortality Table or the Commissioners 1961 Industrial Extended Term Insurance Table. If the commissioner approves by regulation any commissioners standard industrial mortality table adopted by the NAIC for use in determining the minimum nonforfeiture standard for policies issued on or after the

operative date of the valuation manual, that minimum nonforfeiture standard shall supersede the minimum nonforfeiture standard provided by the valuation manual.

(c) Nonforfeiture interest rate.--Notwithstanding any provision of The Insurance Company Law of 1921, the nonforfeiture rate shall be as follows:

(1) For policies issued prior to the operative date of the valuation manual, the nonforfeiture interest rate per year for any policy issued in a particular calendar year shall be equal to 125% of the calendar year statutory valuation interest rate for the policy as defined in section 7117 (relating to computation of minimum standard by calendar year of issue) rounded to the nearest 0.25%, but the nonforfeiture interest rate shall not be less than 4%.

(2) For policies issued on and after the operative date of the valuation manual, the nonforfeiture interest rate per year for any policy issued in a particular calendar year shall be provided by the valuation manual.
40 Pa.C.S. § 4516 — PA Code / Title 40 / Chapter 45 / Section 4516
Certification.
Status: in_force

(a) Requirement.--No later than the April 15 that is at least one year after the effective date of this section, and each April 15 thereafter, each insurer domiciled in this Commonwealth shall submit to the commissioner, in the form and manner prescribed by the department, a written statement certifying that the insurer is in compliance with the requirements of sections 4512 (relating to risk assessment), 4513 (relating to information security program), 4514 (relating to corporate oversight) and 4515 (relating to oversight of third-party service provider arrangements).

(b) Documentation.--

(1) Each insurer shall maintain all records, schedules and data supporting the certification under this section for a period of five years and shall make that information available for examination by the department.

(2) To the extent that an insurer has identified areas, systems or processes that require material improvement, updating or redesign, the insurer shall document the identification and the remedial efforts planned and underway to address the areas, systems or processes. The documentation shall be available for inspection by the department. Cross References. Section 4516 is referred to in sections 4521, 4532, 4536 of this title.