NOTICES
Notice of Requirement to File Forms Under the Accident and Health Filing Reform Act
[28 Pa.B. 4302] Certain group health insurance policies, and other forms, issued by Health Maintenance Organizations, Preferred Provider Organizations, Hospital Plan Corporations and Professional Health Services Plan Corporations were exempted from filing with the Insurance Department (Department) by the Insurance Commissioner (Commissioner) under notices issued April 12, 1997 (27 Pa.B 1893) and June 28, 1997 (27 Pa.B. 3118), under the authority of section 3(a) and 3(b) of the Accident and Health Filing Reform Act (Act 159), act of December 18, 1996 (P. L. 1066, No. 159) (40 P. S. § 3803(a) and (b)).
Section 3(b) of Act 159 (40 P. S. § 3803(b)) authorizes the Commissioner to require any forms exempted from filing to be subsequently made subject to filing again with the Department upon 90 days advance notice published in the Pennsylvania Bulletin. By this publication, the Commissioner hereby communicates her intent to temporarily discontinue the form filing exemption with respect to those forms issued by ''managed care plans,'' as that term is defined by the Quality Health Care Accountability and Protection provisions of Act 68 of 1998 (Act 68) (P. L. 446, No. 68), which are necessary to meet the requirements of Act 68.
Act 68 imposes new requirements on managed care plans and licensed insurers effective January 1, 1999. The requirements include, but are not limited to, disclosure of specified information by managed care plans to enrollees and, under certain circumstances, to prospective enrollees and health care providers. The Department has determined that it is in the public interest to initially review the enrollee material issued by managed care plans to meet these statutory changes. The Department will review only the initial changes made to forms for compliance with Act 68. Future changes to forms need not be filed with the Department and will return to the exemption from filing under the April and June 1997 notices referenced above.
This modification in the exemption of accident and health forms filings shall be effective 90 days after publication of this notice in the Pennsylvania Bulletin. However, because of the anticipated volume of filings from managed care plans, and in an effort to meet the January 1, 1999 effective date of Act 68, the Department will begin reviewing Act 68 compliance filings received prior to the effective date of this notice.
Under this modification, managed care plans shall file with the Department, under the requirements of sections 3 and 4 of Act 159 (40 P. S. § 3803 and 3804), all enrollee material, including but not limited to, subscriber and group master contracts, amendments, riders, endorsements and member handbooks which will be used to disclose the information required by Act 68 to enrollees, prospective enrollees and health care providers.
The discontinuance of this exemption from filing the forms identified above (the modification), shall apply only for the revisions to enrollee material made necessary by Act 68. Other changes and modifications to existing forms not relating to Act 68 may be made using the deregulation process outlined in the April and June 1997 notices referenced above. The deregulation of group accident and health forms will resume under Act 159 for each individual managed care plan after that managed care plan files the required amendments with the Department and these amendments have been reviewed by the Department under the requirements of Act 159.
M. DIANE KOKEN,
Insurance Commissioner
[Pa.B. Doc. No. 98-1417. Filed for public inspection August 28, 1998, 9:00 a.m.]
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