§ 301.303. Certificate of authority.
(a) HMOs are required to obtain a certificate of authority issued jointly by the Department and the Department of Health in accordance with applicable statutes and regulations. See sections 4 and 5.1 of the act (40 P. S. § § 1554 and 1555.1) and § § 301.41 and 301.42 (relating to prohibition against uncertified HMOs; and content of application for certificate of authority).
(b) Under the act, persons or entities are acting as an HMO and are obligated to obtain a certificate of authority if the person or entity directly or through arrangements with others does the following:
(1) Solicits or enrolls members in a plan that will deliver prepaid basic health services.
(2) Delivers prepaid basic health services to those members.
(c) If a person or entity is delivering prepaid basic health services to HMO members, but not soliciting or enrolling members in a plan, that person or entity is not required to obtain a certificate of authority. If the person or entity is delivering prepaid basic health services and performing administrative services or other similar functions, but not soliciting or enrolling HMO members, that person or entity is not required to obtain a certificate of authority.
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