reglab/housing_qa huggingface dataset:
40 PA Cons Stat § 3517 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 35 - Medical Professional Liability Reciprocal Exchange-to-Stock Conversion|Section 3517 - Prohibition on acquisition of control

§ 3517. Prohibition on acquisitions of control. Except as otherwise specifically provided in section 3503 (relating to contents of plan of conversion), from the date a plan of conversion is adopted until the effective date of the plan of conversion, a person may not directly or indirectly offer to acquire, make an announcement to acquire or acquire in any manner, including making a filing with the department for acquisition under a statute or regulation of this Commonwealth, the beneficial ownership of 10% or more of a class of a voting security of the attorney or the stock company that will be the successor of the reciprocal insurer or of a person that controls the voting securities of the attorney or the stock company that will be the successor of the reciprocal insurer.
40 PA Cons Stat § 3701 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 37 - Unclaimed Life Insurance Benefits|Section 3701 - Purpose of chapter

§ 3701. Purpose of chapter. The purpose of this chapter is to require the complete and proper disclosure, transparency and accountability relating to a method of payment for life insurance death benefits regulated by the Insurance Department.
40 PA Cons Stat § 3704 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 37 - Unclaimed Life Insurance Benefits|Section 3704 - Applicability

§ 3704. Applicability. 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 Cons Stat § 3705 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 37 - Unclaimed Life Insurance Benefits|Section 3705 - Enforcement

§ 3705. Enforcement. (a) Actions.--Upon a determination by hearing that an insurer has violated this chapter, the commissioner may pursue one or more of the following courses of action:  (1) issue an order requiring the insurer to cease and desist from engaging in the violation or suspend, revoke or refuse to issue the certificate of qualification or license of the offending insurer.  (2) impose a civil penalty of not more than $5,000 for each violation. (b) Additional remedies or penalties.--The enforcement remedies imposed under this section shall be in addition to any other remedies or penalties imposed by statute.  (c) Administrative procedure.--An action or adjudication of the commissioner under this section shall be preceded by a hearing in accordance with 2 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of Commonwealth agencies) and shall be subject to review and appeal in accordance with 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial review of Commonwealth agency action).
40 PA Cons Stat § 3706 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 37 - Unclaimed Life Insurance Benefits|Section 3706 - Regulations

§ 3706. Regulations. The commissioner may promulgate rules and regulations to administer the provisions of this chapter.
40 PA Cons Stat § 3801 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 38 - Retroactive Denial of Reimbursements|Section 3801 - Scope of chapter

§ 3801. Scope of chapter. 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 Cons Stat § 3802 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 38 - Retroactive Denial of Reimbursements|Section 3802 - Definitions

§ 3802. Definitions. 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) Chapter 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations).  "Reimbursement." Payments made to a health care provider by an insurer.  "Waste." The overutilization of professional medical services or the misuse of resources by a health care provider.
40 PA Cons Stat § 3803 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 38 - Retroactive Denial of Reimbursements|Section 3803 - Retroactive denial of reimbursement

§ 3803. Retroactive denial of reimbursement. (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 Cons Stat § 3804 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 38 - Retroactive Denial of Reimbursements|Section 3804 - Exceptions to retroactive denial of reimbursement

§ 3804. Exceptions to retroactive denial of reimbursement. The provisions of section 3803 (relating to retroactive denial of reimbursement) do not apply if an insurer retroactively denies reimbursement to a health care provider because any of the following apply:  (1) The information submitted to the insurer constitutes fraud, waste or abuse as defined in this chapter.  (2) The claim submitted to the insurer was a duplicate claim. (3) Denial was required by a Federal or State government plan. (4) Services were subject to coordination of benefits with another insurer, the medical assistance program or the Medicare program.    Cross References. Section 3804 is referred to in sections 3803, 3805 of this title.
40 PA Cons Stat § 3805 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 38 - Retroactive Denial of Reimbursements|Section 3805 - Coordination of benefits

§ 3805. Coordination of benefits. 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 Cons Stat § 3806 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 38 - Retroactive Denial of Reimbursements|Section 3806 - Tolling

§ 3806. Tolling. An insurer may request medical or billing records in writing from a health care provider under section 3803 (relating to retroactive denial of reimbursement). The health care provider shall provide the necessary records to the insurer within 60 days of the request. The period of time in which the health care provider is gathering the requested documentation shall be added to the 24-month period.
40 PA Cons Stat § 3901 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3901 - Purposes and scope of chapter

§ 3901. Purposes and scope of chapter. (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 Cons Stat § 3902 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3902 - Definitions

§ 3902. Definitions. 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:  "Board." The board of directors of the filing entity.  "CGAD-related information." The CGAD or any documents, materials or other information, including proprietary and trade secret information or documents, related to an insurer or insurance group's CGAD.  "Commissioner." The Insurance Commissioner of the Commonwealth.  "Corporate governance annual disclosure" or "CGAD." The confidential report filed by the insurer or insurance group in accordance with the requirements of this chapter.  "Department." The Insurance Department of the Commonwealth.  "Insurance Company Law." The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921.  "Insurance group." The insurers and affiliates included within an insurance holding company system as defined in section 1401 of the Insurance Company Law.  "Insurer." A fraternal benefit society, a health maintenance organization, a preferred provider organization, a company, an association, an exchange, a hospital plan corporation as defined in and subject to Chapter 61 (relating to hospital plan corporations) or a professional health services plan corporation subject to Chapter 63 (relating to professional health services plan corporations) authorized by the commissioner to transact the business of insurance in this Commonwealth.  "Lead state." The state responsible for coordination and communication among state regulators regarding oversight of an insurance group, as determined by the department in consultation with other regulators with domestic insurers in the insurance group.  "NAIC." The National Association of Insurance Commissioners or successor organization and its affiliates and subsidiaries.  "Senior management." A corporate officer or other high-level management official responsible for reporting information to the board of directors at regular intervals, providing information to shareholders or providing information to regulators.
40 PA Cons Stat § 3903 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3903 - Submittal of CGAD

§ 3903. Submittal of CGAD. (a) General rule.-- (1) Beginning January 1, 2020, a domestic insurer or an insurance group of which this Commonwealth is the lead state shall submit to the department a CGAD no later than June 1 of each calendar year.  (2) If a domestic insurer is a member of an insurance group of which this Commonwealth is not the lead state, the insurer shall submit the report required by this section to the commissioner of the lead state for the insurance group in accordance with the laws of the lead state.  (b) Exception.--An insurer or insurance group not required to submit a CGAD to the department under subsection (a) shall submit a copy of the most current version of its CGAD to the department upon the commissioner's request.  (c) Amendments.--Each year following the initial filing of the CGAD, the filing entity shall file an amended version of the previously filed CGAD indicating where changes have been made. If no changes were made in the information or activities reported by the filing entity, the filing should so state.  (d) Format.--The filing entity may exercise discretion regarding the appropriate format for providing the information required in this chapter and may customize the CGAD to provide the most relevant information necessary to permit the department to understand the corporate governance structure, policies and practices utilized by the filing entity. The department shall include a sample template on its publicly accessible Internet website.
40 PA Cons Stat § 3905 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3905 - Review of CGAD

§ 3905. Review of CGAD. (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 Cons Stat § 3906 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3906 - Third-party consultants

§ 3906. Third-party consultants. (a) Assistance with review.--The department may retain, at the insurer or insurance group's expense, third-party consultants, including attorneys, actuaries, accountants and other experts not otherwise a part of the department's staff as may be reasonably necessary to assist the department in reviewing the CGAD, CGAD-related information or the insurer's or insurance group's compliance with this chapter. Before retaining a third-party consultant, the department shall consider all of the following:  (1) The complexity of the corporate governance structure of the insurer or insurance group. (2) Whether subject matter expertise to effectively review the report is available within the department.  (b) Advisory capacity.--A person retained under subsection (a) shall be under the direction and control of the department and shall act in a purely advisory capacity.  (c) Confidentiality.--Each third-party consultant shall be subject to the same confidentiality standards and requirements as the department.  (d) Verification.--As part of the retention process, a third-party consultant shall verify to the department, with notice to the insurer or insurance group, that it:  (1) is free of a conflict of interest; (2) will comply with the confidentiality standards and requirements of this chapter; and (3) has internal procedures in place to monitor compliance with this section. (e) Written consent.--A retention agreement with a third-party consultant shall expressly require the written consent of the insurer or insurance group prior to making information provided under this chapter public.    Cross References. Section 3906 is referred to in section 3907 of this title.
40 PA Cons Stat § 3908 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3908 - Penalties

§ 3908. Penalties. 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 Cons Stat § 3909 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3909 - Rules and regulations

§ 3909. Rules and regulations. The department may promulgate rules and regulations and issue orders necessary to administer and enforce this chapter.
40 PA Cons Stat § 3910 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3910 - Construction

§ 3910. Construction. Nothing in this chapter shall be construed to prescribe or impose corporate governance standards and internal procedures in addition to those required under applicable State corporate law. Notwithstanding the foregoing, nothing in this chapter shall be construed to limit the commissioner's authority or the rights or obligations of third parties under Article IX of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of 1921.
40 PA Cons Stat § 3911 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 39 - Corporate Governance Annual Disclosure|Section 3911 - Severability

§ 3911. Severability. (a) General rule.--Except as provided in subsection (b):  (1) The provisions of this chapter are severable. (2) If a provision of this chapter or its application to a person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter that can be given effect without the invalid provision or application.  (b) Exception.--If the addition of section 3907 (relating to confidentiality) is held invalid, independent of its application to a person or circumstance, the remaining provisions or applications of this chapter are void.
40 PA Cons Stat § 4001 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 40 - Medication Sychronization|Section 4001 - Definitions

§ 4001. Definitions. 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) Chapter 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations).  "Maintenance medication." A medication prescribed for a chronic, long-term condition and taken on a regular, recurring basis.  "Medication synchronization." The coordination of prescription drug filling or refilling by a pharmacy or dispensing physician for a health insurance enrollee taking two or more maintenance medications for the purpose of improving medication adherence.  "Pharmacy." As defined in section 2 of the act of September 27, 1961 (P.L.1700, No.699), known as the Pharmacy Act.
40 PA Cons Stat § 4002 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 40 - Medication Sychronization|Section 4002 - Prorated daily cost-sharing rate

§ 4002. Prorated daily cost-sharing rate. A health insurance policy shall permit and apply a prorated daily cost-sharing rate to maintenance medications that are dispensed by a pharmacy as a partial supply if the pharmacist or prescriber 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. The fill or refill under this section shall be limited to three times per year for each maintenance medication for a covered individual. For each clinically necessary synchronization thereafter, approval may be required at the discretion of the health insurance policy.
40 PA Cons Stat § 4003 (2021)
2021 Pennsylvania Consolidated & Unconsolidated Statutes|Title 40 - INSURANCE|Chapter 40 - Medication Sychronization|Section 4003 - Denial of coverage

§ 4003. Denial of coverage. (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.