reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.9 - Existing agreements

Current through Register Vol. 54, No. 28, July 13, 2024
Insurers subject to this chapter shall reduce to zero by
				  December 31, 1995, reserve credits or assets established with respect to
				  reinsurance agreements entered into prior to September 12, 1993, which, under
				  this chapter would not be entitled to recognition of the reserve credits or
				  assets but the reinsurance agreements shall have been in compliance with laws
				  or regulations in existence immediately preceding September 12,
				  1993.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.2 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
Section 319.1(b) of the act (40 P. S. §
										442.1(b)) establishes
				  conditions whereby a domestic ceding insurer may be allowed to take credit for
				  reinsurance when the assuming reinsurer is an unlicensed, unqualified
				  reinsurer. This chapter establishes minimum requirements for trust agreements,
				  letters of credit and other forms of acceptable security for which credit will
				  be allowed for reinsurance ceded to unlicensed, unqualified reinsurers.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.3 - Scope

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter applies to licensed domestic insurers subject to
				  section 319.1(b) of the act (40 P. S. §
										442.1(b)) relating to credit
				  for collateralized reinsurance with unlicensed, unqualified
				  reinsurers.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.4 - Funds held in trust

Current through Register Vol. 54, No. 28, July 13, 2024
Trust agreements established for funds held on behalf of a
				  domestic ceding insurer as security for the payment of the obligations of an
				  unlicensed, unqualified reinsurer shall comply with section 319.1(b)-(e) of the
				  act (40 P. S. §
										442.1(b)-(e)) and this
				  chapter.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.5 - General requirements for trust agreements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A trust agreement shall be entered into
				between the beneficiary, the grantor and a trustee.
(b) A trust agreement shall be established
				for the sole benefit of the beneficiary.
(c) A trust agreement shall be made subject
				to and governed by the laws of the state in which the trust is
				established.
(d) A trust agreement
				may not be subject to any conditions or qualifications outside of the trust
				agreement.
(e) A trust agreement
				may not be conditioned upon any other agreements or documents, except for the
				reinsurance agreement for which the trust agreement is established.
(f) A trust agreement may not transfer
				liability from the trustee for the trustee's own negligence, willful misconduct
				or lack of good faith.
(g) A trust
				agreement shall create a trust account into which the assets shall be
				deposited.
(h) A trust agreement
				shall prohibit invasion of the trust corpus for the purpose of paying
				compensation to or reimbursing the expenses of the trustee.
(i) A trust agreement shall prohibit the
				grantor from terminating the trust agreement on the basis of the insolvency of
				the beneficiary.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.6 - Requirements for assets held in trust accounts

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Assets in the trust account shall be in
				the form of security permitted by section
				319.1(b) of the
				act (40 P. S. §
										442.1(b)) and shall be
				valued at current fair market value.
(b) A trust agreement shall permit
				substitution or withdrawal of assets from the trust account only as provided by
				the following:
(1) Within 6 months of the
				date the trust account is funded, no substitution or withdrawal of assets may
				occur except on written instructions from the beneficiary for each individual
				substitution or withdrawal at the time the substitution or withdrawal is
				executed.
(2) After 6 months from
				the date the trust account is funded, no substitution or withdrawal of assets
				may occur except in accordance with prior written instructions from the
				beneficiary listing specific types of permitted substitutions or withdrawals of
				assets that the trustee determines are at least equal in market value to the
				assets withdrawn and that are in the form permitted by section
				319.1(b) of the
				act and subsection (a); except that, if a substitution or withdrawal of assets,
				together with other substitutions or withdrawals made within the preceding 12
				months, exceeds 50% of the total fair market value of the assets as of the
				first day of the first month within the preceding 12-month period, the
				substitution or withdrawal shall be made only on written instructions from the
				beneficiary for each individual substitution or withdrawal at the time the
				substitution or withdrawal is executed.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.7 - Duties and responsibilities of trustees

Current through Register Vol. 54, No. 28, July 13, 2024
A trust agreement shall require the trustee to:
(1) Receive and hold the assets in a safe
				place at an office of the trustee in the United States.
(2) Determine that the assets are in a form
				so that the beneficiary, or the trustee upon direction by the beneficiary, may
				negotiate the assets without consent or signature from the grantor or another
				person.
(3) Furnish to the grantor
				and the beneficiary a statement of the assets in the trust account upon the
				inception of the account and at the end of each calendar quarter.
(4) Notify the grantor and the beneficiary
				within 10 days of any deposits to or withdrawals from the trust account; except
				as provided in §
									163.6(b)
				(relating to requirements for assets held in trust accounts).
(5) Upon written demand of the beneficiary,
				immediately take the steps necessary to transfer absolutely and unequivocally
				all right, title and interest in the assets held in the trust account to the
				beneficiary and deliver physical custody of the assets to the
				beneficiary.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.8 - Resignation or removal of trustee

Current through Register Vol. 54, No. 28, July 13, 2024
This section applies if the resignation or removal of a
				  trustee does not result in the termination of the trust agreement under §
									163.9 (relating to termination of
				  trust agreements):
(1) The trustee may
				resign upon delivery of a written notice of resignation, effective no later
				than 90 days after notice to the beneficiary and grantor.
(2) The trustee may be removed by the grantor
				by delivery to the trustee and the beneficiary of a written notice of removal,
				effective no later than 90 days after notice to the trustee and the
				beneficiary.
(3) The resignation or
				removal of the trustee may not be effective until the following requirements
				have been met:
(i) A successor trustee has
				been appointed and approved by the beneficiary and the grantor.
(ii) A trust agreement has been executed by
				the successor trustee which complies with section 319.1(b)-(e) of the act
				(40
				P. S. §
											442.1(b)-(e))
				and this chapter.
(iii) The
				possession of, and title to, all assets in the trust have been transferred to
				the new trustee.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.9 - Termination of trust agreements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
				trustee shall deliver written notification of termination to the beneficiary at
				least 30 days, but not more than 45 days, prior to termination of the trust
				account.
(b) Upon termination of
				the trust account, assets not previously withdrawn by the beneficiary may not
				be delivered to the grantor except with the written approval of the
				beneficiary.
This section cited in 31 Pa. Code §
											163.8 (relating to resignation or
					 removal of trustee).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.10 - Permitted provision in trust agreements

Current through Register Vol. 54, No. 28, July 13, 2024
The grantor may have the full and unqualified right to vote
				  any shares of stock in the trust account and to receive from time to time
				  payments of any dividends or interest upon any shares of stock or obligations
				  included in the trust account.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.11 - Requirements for provisions in reinsurance agreements entered into in conjunction with trust agreements

Current through Register Vol. 54, No. 28, July 13, 2024
When a reinsurance agreement is entered into in conjunction
				  with a trust agreement and the establishment of a trust account, either the
				  reinsurance agreement or the trust agreement shall contain provisions
				  that:
(1) Require the reinsurer to
				enter into a trust agreement and to establish a trust account for the benefit
				of the reinsured.
(2) Specify what
				recoverables and reserves, or both, the agreement is to cover.
(3) Require the reinsurer, prior to
				depositing assets with the trustee, to execute assignments or endorsements in
				blank, or transfer legal title to the trustee of all shares, obligations or
				other assets requiring assignments so that the ceding insurer, or the trustee
				upon the direction of the ceding insurer, may negotiate these assets without
				consent or signature from the reinsurer or any other entity.
(4) Require that all settlements of account
				between the ceding insurer and the reinsurer be made in cash or its
				equivalent.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.12 - Accounting in statutory financial statements for credit for reinsurance secured by trust agreements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A trust
				agreement established in compliance with this chapter may be used by a domestic
				ceding insurer to take credit for reinsurance ceded to an unlicensed,
				unqualified reinsurer in a financial statement required to be filed with the
				Department if the trust agreement is executed and the trust account is
				established and funded on or before the date on which the domestic ceding
				insurer files the financial statement.
(b) Credit for reinsurance shall be allowed
				for reinsurance ceded to an unlicensed, unqualified reinsurer only if the trust
				account is established in compliance with this chapter. The credit may not
				exceed the lesser of the current fair market value of assets available to be
				withdrawn from the trust account or the specific obligations under the
				reinsurance agreement that the trust account was established to
				secure.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.13 - Existing trust agreements and underlying reinsurance agreements

Current through Register Vol. 54, No. 28, July 13, 2024
Domestic ceding insurers may continue to take credit for
				  reinsurance ceded to unlicensed, unqualified reinsurers under reinsurance
				  agreements with underlying trust agreements when both the reinsurance
				  agreements and the underlying trust agreements were executed prior to January
				  18, 1997, if the reinsurance agreements and trust agreements were executed in
				  compliance with applicable State laws and regulations in existence immediately
				  preceding January 18, 1997, until January 19, 1998, after which no credit will
				  be allowed until the reinsurance agreements and underlying trust agreements are
				  brought into compliance with this chapter.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.14 - Letters of credit

Current through Register Vol. 54, No. 28, July 13, 2024
Letters of credit held by or on behalf of a domestic ceding
				  insurer as security for the payment of the obligations of an unlicensed,
				  unqualified reinsurer under a reinsurance agreement shall meet the requirements
				  of section 319.1(b)-(e) of the act (40 P. S. §
										442.1(b)-(e)) and this
				  chapter.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.15 - Requirements for letters of credit

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A letter of credit shall:
(1) Be clean, irrevocable, unconditional and
				evergreen as provided under section 319.1(b)(3)(i) of the act (40 P. S. §
											442.1(b)(3)(i)).
(2) Contain an issue date and date of
				expiration with a term of at least 1 year.
(3) Contain an evergreen clause which
				prevents the expiration of the letter of credit without due notice from the
				issuer and provides for at least 30 days notice prior to expiration date or
				nonrenewal.
(4) Stipulate that the
				beneficiary need only draw a sight draft under the letter of credit and present
				it to obtain funds and that no other document need be presented.
(5) Indicate that it is not subject to any
				condition or qualifications outside of the letter of credit.
(6) Be conditioned upon no other agreement,
				document or entity, except for the reinsurance agreement for which the letter
				of credit is issued.
(7) Include a
				clearly marked section which indicates that it contains information for
				internal identification purposes only and which contains the name of the
				applicant and other appropriate notations to provide a reference for the letter
				of credit.
(8) Contain a statement
				to the effect that the obligation of the qualified United States financial
				institution, as defined in section
				319.1(g) of the
				act, under the letter of credit is in no way contingent upon reimbursement of
				the issuer by the applicant with respect thereto.
(9) Contain a statement that the letter of
				credit is subject to and governed by the Uniform Customs and Practice for
				Documentary Credits of the International Chamber of Commerce (Publication 500
				or subsequent updates) and the laws of the Commonwealth, and drafts drawn
				thereunder shall be presentable at an office of a qualified United States
				financial institution.
(10) Contain
				a provision for an extension of time to draw against the letter of credit in
				the event that one or more of the occurrences specified in Article 17 of
				Publication 500 (or subsequent updates) occur.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.16 - Provisions in reinsurance agreements entered into inconjunction with letters of credit

Current through Register Vol. 54, No. 28, July 13, 2024
When a reinsurance agreement is entered into in conjunction
				  with a letter of credit, either the reinsurance agreement or an ancillary
				  agreement thereto shall contain provisions that:
(1) Require the reinsurer to provide letters
				of credit to the ceding insurer.
(2) Specify what recoverables and reserves
				are covered by the letter of credit.
(3) Specify that notice of nonrenewal of the
				letter of credit is a reason that the ceding insurer may draw down the full
				amount of the letter of credit.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.17 - Accounting in statutory financial statements for credit for reinsurance secured by letters of credit

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A letter of
				credit may not be used by a domestic ceding insurer to take credit for
				reinsurance ceded to an unlicensed, unqualified reinsurer unless the letter of
				credit has been issued with the domestic ceding insurer listed as a beneficiary
				and is in compliance with section 319.1 of the act (40 P. S. §
										442.1) and this chapter.
(b) Credit for reinsurance secured by a
				letter of credit shall be allowed in an amount not exceeding the lesser of the
				amount of the letter of credit or the specific obligations under the
				reinsurance agreement which the letter of credit was issued to
				secure.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.18 - Existing letters of credit

Current through Register Vol. 54, No. 28, July 13, 2024
Domestic ceding insurers may continue to take credit for
				  reinsurance secured by letters of credit where both the reinsurance agreements
				  and underlying letters of credit were executed prior to January 18, 1997, if
				  the reinsurance agreements and letters of credit were in compliance with
				  applicable State laws and regulations in existence immediately preceding
				  January 18, 1997, until January 19, 1998, or the renewal date of the letter of
				  credit, whichever time is less, after which no credit will be allowed until the
				  reinsurance agreements and letters of credit are brought into compliance with
				  this chapter.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.19 - Actions or rights of the Commissioner

Current through Register Vol. 54, No. 28, July 13, 2024
The failure of a trust agreement or letter of credit to
				  specifically identify the beneficiary as defined in §
									163.1 (relating to definitions) to
				  include a court appointed domiciliary receiver may not be construed to prevent
				  the Commissioner from becoming the successor of the beneficiary as a court
				  appointed domiciliary receiver or to otherwise affect any rights which the
				  Commissioner may possess under the laws and regulations of the
				  Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 163 - REQUIREMENTS FOR FUNDS HELD AS SECURITY FOR THE PAYMENT OF OBLIGATIONS OF UNLICENSED, UNQUALIFIED REINSURERS › Section 163.20 - Other security acceptable to the Commissioner

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A domestic ceding insurer may take credit
				for reinsurance for funds or letters of credit provided by a noninsurer parent
				corporation of the ceding insurer if the requirements of section 319.1(b)(4) of
				the act (40 P. S. §
										442.1(b)(4)) are met, as
				follows:
(1) The funds or letters of credit
				are held subject to withdrawal by, and under the control of, the ceding
				insurer.
(2) The type, amount and
				form of the funds or letters of credit receive the prior approval of the
				Commissioner.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 165 - WORKERS' COMPENSATION SECURITY FUND › Section 165.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
The purpose of this chapter is to:
(1) Establish how contributions are made to
				the Fund.
(2) Ensure that a person,
				entitled to workers' compensation payments from insolvent carriers, will still
				have a source of funds on which to draw those payments.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 165 - WORKERS' COMPENSATION SECURITY FUND › Section 165.4 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings, unless the context indicates otherwise:
Act
-The Workers Compensation Security Fund
				  Act (77 P. S. §§
										1051-1066).
Carrier
-As defined in section 2 of the act
				  (77
				  P. S. §
										1052).
Certificate of authority
-As required by
				  section 208 of The Insurance Department Act of 1921 (40 P. S. §
										46).
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Fund
-As defined in section 2 of the
				  act.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 165 - WORKERS' COMPENSATION SECURITY FUND › Section 165.5 - Administration

Current through Register Vol. 54, No. 28, July 13, 2024
The Fund may secure, using Commonwealth procurement
				  standards:
(1) A third party
				administrator to perform claim assessment and handling, and administrative
				duties and responsibilities.
(2)
				Actuarial services to provide an annual liability report and to do the analysis
				described in §
									165.6 (relating to amount of fund)
				to determine the assessment.
This section cited in 31 Pa. Code §
											165.7 (relating to
					 assessment).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 165 - WORKERS' COMPENSATION SECURITY FUND › Section 165.6 - Amount of Fund

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A minimum
				balance of $500 million shall be maintained in the Fund.
(b) If, due to the payment of liabilities or
				claims, the balance of the Fund is reduced below $500 million, the Department,
				in order to return the Fund to the $500 million level, will require
				contributions sufficient to fund:
(1) The
				current shortage below $500 million.
(2) Plus the expected payment of liabilities
				for the next calendar year.
(3)
				Plus expenses to administer the Fund for the next calendar year.
(4) Less expected investment earnings on the
				Fund balance during the next calendar year.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 165 - WORKERS' COMPENSATION SECURITY FUND › Section 165.7 - Assessment

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The amount of
				an assessment will be determined by using the actuarial services described in
				§
									165.5 (relating to
				administration).
(b) Every carrier,
				doing the business of workers' compensation insurance in this Commonwealth,
				will be assessed, based on a prorata share of the total amount of net-written
				premiums of workers' compensation insurance reported as written in the previous
				calendar year's annual statement.
(c) The assessment, when necessary, will be
				billed by December 31 of the year that the actuarial study is completed.
				(Example: Data from the 2002 calendar year is used, the actuarial study is
				completed in 2003, then the assessment will be made by December 31,
				2003.)
(d) Payment of the
				assessment, when applicable, is due by March 31 of the year following the
				assessment.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 165 - WORKERS' COMPENSATION SECURITY FUND › Section 165.8 - Failure to comply

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a carrier
				fails to file a return, or make any payment required by the act, or in case the
				Commissioner has cause to believe that a return or other statement filed is
				false or inaccurate in any particular, or that a payment made is incorrect, the
				Commissioner has full authority to examine all the books and records of the
				carrier for the purpose of ascertaining the facts and determine the correct
				amount to be paid. The Commissioner may proceed in any court of competent
				jurisdiction to recover for the benefit of the Fund any sums shown to be due
				upon the examination and determination.
(b) A carrier that fails to make a statement
				as required by the act, or to pay any contribution when due, thereby forfeits
				to the Fund a penalty of 5% of the amount of unpaid contribution determined to
				be due, as provided by the act, plus 1% of the amount for each month of delay
				or fraction thereof after the expiration of the first month of the
				delay.
(c) The Commissioner will
				revoke the certificate of authority to do business in this Commonwealth of a
				carrier which fails to comply with the act or to pay a penalty imposed in
				accordance with the act.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 167 - WORKERS' COMPENSATION ACT-PROVIDER FEES › Section 167.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
The purpose of this chapter is to set the allowance for
				  anesthesia services provided to patients under the Workers' Compensation Act
				  (77
				  P. S. §§
										1-2626) when the allowance
				  utilizes the anesthesia conversion factor.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 167 - WORKERS' COMPENSATION ACT-PROVIDER FEES › Section 167.2 - Payment for anesthesia services

Current through Register Vol. 54, No. 28, July 13, 2024
The Workers' Compensation Part B Fee Schedule shall be
				  amended by multiplying the anesthesia conversion factor applicable to Codes
				  100-1999 by a multiplier of 1.632. The Fee Schedule, as amended, shall apply to
				  anesthesia services provided in all regions after December 4,
				  2004.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
The purpose of this chapter is to provide uniform procedures
				  and forms to enable insurance companies and self-insurers to comply with the
				  liability insurance provisions of the act, to promulgate guidelines and
				  requirements governing the purchase of insurance by health care providers as
				  mandated by the act, and to issue regulations necessary to properly effectuate
				  the administrative and financial operations of the Fund.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings, unless the context clearly indicates otherwise:
Act
-The Health Care Services Malpractice Act
				  (40
				  P. S. §§
										1301.101-1301.1006).
Basic insurance coverage
-Insurance or
				  self-insurance with limits of liability which comply with the occurrence-based
				  requirements of the act in section 701 of the act (40 P. S. §
										1301.701). In the case of a claims made
				  policy permitted under sections 103 and 807 of the act (40 P. S.
				  §§
										1301.103 and
				  1301.807), the insurance
				  requirements of the act require purchase of the reporting endorsement (that is,
				  tail coverage) or prior acts coverage or its substantial equivalent by the
				  health care provider, upon cancellation or termination of the claims made
				  policy.
Cost to each health care provider
-The gross
				  premium, including experience and schedule rating for basic coverage
				  professional liability insurance.
Department
-The Insurance Department of the
				  Commonwealth.
Director
-The Office of the Director of the
				  Medical Professional Liability Catastrophe Loss Fund.
Emergency surcharge
-A surcharge levied by
				  the Insurance Commissioner under section 701(e) of the act (40 P. S. §
										1301.701(e)).
Fund
-The Medical Professional Liability
				  Catastrophe Loss Fund established by section 701 of the act (40 P. S. §
										1301.701).
Gross premium
-The entire premium charged the
				  insured, including, but not limited to, binder charges and policy fees, as is
				  generated to secure an occurrence-based policy. In the case of a claims made
				  policy, the gross premium shall be computed as the sum of all the premiums
				  charged for the claims made policy including the reporting endorsement (that
				  is, tail coverage) or prior acts coverage or its substantial equivalent.
				  Payment of the surcharge shall be made at the time that the respective premium
				  is collected subject to the limitation of §
									242.6(a)(3)
				  (relating to reporting forms and procedures).
Health care provider
-Health care provider
				  as defined by the act.
Insurer
-The insurance company providing
				  basic coverage insurance.
The provisions of this §
											242.2 issued under sections 206
					 and 506 of The Administrative Code of 1929 (71 P. S. §§
												66 and
					 186); and sections 701(e)(4)
					 and 702(a) of the Health Care Services Malpractice Act (40 P. S.
					 §§
												1301.701(e)(4)
					 and 1301.702(a)).
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.3 - Notice of and amount of surcharge

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				The Director, with the prior approval of the Insurance Commissioner, will
				publish, prior to December 1, in the
Pennsylvania Bulletin
,
				notice of a change in the amount of surcharge applicable to health care
				providers and collectible during the following calendar year.
(b) The effective date of a change in the
				amount of surcharge shall be January 1 and shall be applicable to policies of
				basic coverage insurance or plans of self-insurance having new or renewal dates
				occurring on or after January 1.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.4 - Computation of surcharge when professional liability insurance premium part of a composite rate

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Where the
				professional liability insurance premium of an insured is included in a
				composite rate or with other insurance coverage, it shall be the responsibility
				of the insurer to accurately compute the portion attributable to the
				professional liability insurance, in order to properly determine the
				surcharge.
(b) Premiums subject to
				rating adjustments or audits, or both, shall be recomputed at the time of the
				adjustment or audit to determine the gross premium to which the surcharge is
				applicable.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.5 - Adjustment of surcharge

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				Calculation of the surcharge shall be made based on the first policy written or
				renewed after January 1 of the calendar year. The surcharge amount shall be
				submitted to the Fund within 60 days of the effective date required by §
									242.6 (relating to reporting forms
				and procedures). A subsequent adjustment to the premium for the basic insurance
				coverage shall be reported to the Fund by the basic insurance carrier and the
				surcharge shall be adjusted accordingly.
(b) In the event of an increase or decrease
				in the surcharge owed to the fund, the carrier shall submit proper evidence of
				the modification of the premium for the basic insurance coverage policy and
				shall indicate on the Form 216 a credit or debit to be applied to the account
				of the carrier. A refund check may not be issued to a carrier or health care
				provider unless unusual circumstances arise which indicate that a refund may be
				made.
The provisions of this §
											242.5 issued under sections 206
					 and 506 of The Administrative Code of 1929 (71 P. S. §§
												66 and
					 186); and section 701(e) of
					 the Health Care Services Malpractice Act (40 P. S. §
												1301.701(e)).
This section cited in 31 Pa. Code §
											242.7 (relating to discontinuation
					 of basic coverage insurance and notices of noncompliance); and 31 Pa. Code
					 §
											242.9 (relating to overpayments,
					 credits, and duplicate payments).
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.6 - Reporting forms and procedures

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
				following forms have been promulgated or approved for use under this chapter:
(1)
Form 5116-Acknowledgment of
				Insurance and Surcharge Paid.
This form is intended as the
				acknowledgment from approved self-insured health care providers that they are
				self-insured in compliance with the act and have paid the Fund surcharge. Basic
				coverage insurance carriers may also use this form in lieu of the Declarations
				Page to acknowledge that the health care provider has purchased basic coverage
				professional liability insurance and paid the Fund surcharge, if prior approval
				for its continued use has been obtained from the Fund's legal counsel in
				accordance with paragraph (2)(iii).
(i) The
				original of the form or the Declarations Page-whichever is applicable-is to be
				mailed to the health care provider; and a copy is to be submitted to the Fund,
				accompanied by the surcharge payment and Form 216, within 60 days of the
				effective date of the policy or self-insurance period.
(ii) Licensed physicians and podiatrists
				covered under policies issued to hospitals, nursing homes and primary health
				centers shall also be provided with a completed acknowledgment form. Individual
				copies of the form or the Declarations Page-whichever is applicable-accompanied
				by the surcharge payments for each of these health care providers and Form 216
				are to be submitted to the Fund attached to the acknowledgment form applicable
				to the hospital, nursing home or primary health center.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.7 - Discontinuation of basic coverage insurance and notices of noncompliance

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Cancellation or nonrenewal.
(1) Cancellation or nonrenewal of coverage
				resulting from the request of the insured or the cancellation or nonrenewal by
				the insurer or self insurer automatically releases the Fund from liability for
				claims for injuries or death from services which were rendered or which should
				have been rendered by the health care provider which occur after the effective
				date of cancellation or nonrenewal.
(2) Cancellation or nonrenewal of claims made
				coverage resulting from the request of the insured or the cancellation or
				nonrenewal by the insurer without the purchase of the reporting endorsement,
				prior acts coverage or its substantial equivalent automatically releases the
				Fund from liability for claims for injuries or death from services which were
				rendered or which should have been rendered by the health care provider which
				occur or which are reported to the basic coverage insurance carrier after the
				effective date of cancellation or nonrenewal.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.7a - Allowable time periods for application to fund for surcharge credits as a result of policy cancellations-statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For all policies issued or renewed in
				2001, the Fund should be notified of any cancellation of a health care
				provider's basic coverage insurance policy, or self-insured arrangement, and
				should receive any corresponding application for credit, no later than 1 year
				from the date of the cancellation. For example, if a policy or coverage period
				on a particular health care provider runs from January 1, 2001, to December 31,
				2001, and there is a cancellation of the policy effective September 1, 2001,
				notification of the cancellation and any corresponding application for credit
				shall be reported to the Fund by September 1, 2002, if not sooner. A basic
				coverage insurance carrier or self-insured health care provider will have at
				least 60 days to notify the Fund of a cancellation and provide the Fund with
				the corresponding application for credit.
(b) For policies issued or renewed in 2002,
				and every year thereafter, the Fund should be notified of any cancellation of a
				provider's basic coverage insurance policy, or self-insured arrangement, and
				should receive any corresponding application for credit, within 60 days from
				the date of the cancellation.
(c)
				On a going forward basis, the Fund will not accept applications for surcharge
				credits for policies issued or renewed before January 1, 2001.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.8 - New acknowledgment

Current through Register Vol. 54, No. 28, July 13, 2024
A new Form 5116 shall be issued upon payment of the surcharge
				  on a new or reinstated basic coverage insurance policy.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.9 - Overpayments, credits, and duplicate payments

Current through Register Vol. 54, No. 28, July 13, 2024
When overpayments are made by insureds, agents or insurers,
				  they may be recovered by offsets against amounts due from companies to the
				  Fund. The offsets shall be recorded on Form 216 with minus signs or brackets to
				  distinguish them from debits and shall be accompanied by evidence in support of
				  refunds resulting from premium reductions under §
									242.5(a)(1)
				  (relating to adjustment of surcharge). Surcharge credits of amounts less than
				  $10 may be waived in accordance with the insurer's policy relative to small
				  return premiums.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.10 - Self-insurers

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
				applies to approved and accepted self-insurance plans and
				self-insurers.
(b) Self-insurers
				shall pay the surcharge to the Fund accompanied by the reporting forms required
				under §
									242.6 (relating to reporting forms
				and procedures) within 60 days of the effective date of the self-insurance plan
				and on an annual basis thereafter within 60 days of the inception of the annual
				self-insurance period.
The provisions of this §
											242.10 issued under sections 206
					 and 506 of The Administrative Code of 1929 (71 P. S. §§
												66 and
					 186); section 701(e)(4) of
					 the Health Care Services Malpractice Act (40 P. S. §
												1301.701(e)(4)); and
					 2
					 Pa.C.S. §
												102(a).
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.11 - Notice of claims exceeding basic coverage insurance

Current through Register Vol. 54, No. 28, July 13, 2024
The insurer or self-insurer shall, within 30 days of
				  determining that a claim is likely to exceed the basic coverage of the insurer,
				  or the retained limits of the self-insured, submit Form C416 to the
				  Director.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.12 - Determination of health care provider

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The insurer or self insurer shall be
				responsible for making the initial determination of who is a health care
				provider for purposes of having access to the liability coverage provided by
				the Fund.
(b) The initial
				determination of health care provider status by the insurer or self insurer
				shall not preclude a review of this determination by the Fund.
The provisions of this §
											242.12 issued under section 506 of
					 The Administrative Code of 1929 (71 P. S. §
												186); and sections 701(e)(4) and 702(a) of
					 the Health Care Services Malpractice Act (40 P. S. §§
												1301.701(e)(4) and
					 1301.702(a)).
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.13 - Audits

Current through Register Vol. 54, No. 28, July 13, 2024
The Director has the authority to conduct or arrange audits
				  of the records of insurers, health care providers, and the Joint Underwriting
				  Association, in order to protect the rights and responsibilities of the
				  Fund.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.14 - Bulletins and notices

Current through Register Vol. 54, No. 28, July 13, 2024
Bulletins and notices will be issued periodically by the
				  Director to clarify or modify procedures. Insurers, agents, brokers, health
				  care providers and others requiring the information will, upon request to the
				  Director, be placed on a mailing list for such bulletins.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.15 - Notification to the Director

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Persons accountable.
Insurers and self-insurers shall notify
				the Director in writing of the responsible person accountable for procedures
				and timely remittances applicable to Article VII of the act (40 P. S.
				§§
										1301.701-1301.702).
(b)
Pennsylvania license
				numbers.
Insurers and self-insurers shall record and report the
				Pennsylvania medical license numbers of the health care providers to the
				Director on forms prescribed in this chapter, on new and renewal business
				written subsequent to October 31, 1976.
The provisions of this §
											242.15 issued under section 506 of
					 The Administrative Code of 1929 (71 P. S. §
												186); and sections 701(e)(4) and 702(a) of
					 the Health Care Services Malpractice Act (40 P. S. §§
												1301.701(e)(4) and
					 1301.702(a)).
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.16 - Retention of records

Current through Register Vol. 54, No. 28, July 13, 2024
Insurers and self-insurers shall be responsible for the
				  retention of forms and records described in this chapter, in accordance with
				  the applicable Commonwealth statute of limitations.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.17 - Compliance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The failure of
				the health care provider to comply with section 701 of the act (40 P. S. §
										1301.701) or this chapter will result in
				notification by the Director to the applicable Licensure Board. Section 701(f)
				of the act (40 P. S. §
										1301.701(f)) provides that
				failure of a health care provider to comply with section 701 of the act or
				rules and regulations issued by the Director shall result in the suspension or
				revocation of the health care provider's license by the Licensure
				Board.
(b) A health care provider
				failing to pay the surcharge or emergency surcharge within the time limits
				prescribed will not be covered by the Fund in the event of loss.
(c) A health care provider failing to procure
				increased basic coverage insurance limits under section 701(a) of the act
				(40
				P. S. §
										1301.701(a))
				and pay the surcharge thereon will not be covered by the Fund in the event of
				loss.
(d) The Fund will be relieved
				of its responsibility in the following case:
(1) The Fund will be relieved of its
				responsibility to a health care provider to defend and indemnify a claim
				reported to the Fund under section 605 of the act (40 P. S. §
											1301.605) if, at the time of the occurrence,
				the health care provider fails to maintain basic coverage insurance in
				compliance with the act and this chapter.
(2) Notwithstanding paragraph (1), if at the
				time of the occurrence the health care provider is insured on a claims made
				basis and thereafter fails to purchase the reporting endorsement, prior acts
				coverage or its substantial equivalent upon cancellation or nonrenewal of the
				claims made policy, and subsequently a claim is reported to the Fund under
				section 605 of the act (40 P. S. §
											1301.605), the Fund will be relieved of its
				responsibility to the health care provider to defend and indemnify the claim
				under section 605 of the act.
Pennsylvania Code › Title 31 - INSURANCE › Part IX - Medical Catastrophe Loss Fund › Chapter 242 - MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND › Section 242.18 - Effective date

Current through Register Vol. 54, No. 28, July 13, 2024
The effective date of this chapter as well as the
				  commencement date for using the prescribed forms shall be November 1,
				  1976.