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Pennsylvania Statutes Title 40 P.S. Insurance § 3801.503. Required filings

Current as of January 01, 2025 | Updated by Findlaw Staff

<Chapter 5 of the Accident and Health Filing Reform Act [40 P.S. §§ 3801.501 to 3801.514] effective upon publication of notice under 40 P.S. § 3801.5103.>

(a) Form filings.--Each insurer and HMO shall file with the department any form which it proposes to issue in this Commonwealth except a type or kind of form which, in the opinion of the commissioner, does not require filing.

(b) Notice of exemption from filing.--The commissioner shall issue notice in the Pennsylvania Bulletin identifying any type or kind of form which has been exempted from filing. The commissioner may subsequently require the forms to be filed under this section upon notice published in the Pennsylvania Bulletin. Any such subsequent notice shall not be effective until 90 days after publication.

(c) Individual rates.--Each insurer and HMO shall file with the department rates for individual accident and health insurance policies which it proposes to use in this Commonwealth except those rates which, in the opinion of the commissioner, cannot practicably be filed before they are used. The commissioner shall publish notice in the Pennsylvania Bulletin identifying rates which the commissioner determines cannot practicably be filed.

(d) Certain group rates exempt.--Except as provided in subsection (e), an insurer shall not be required to file with the department rates for accident and health insurance policies which it proposes to issue on a group, blanket or franchise basis in this Commonwealth.

(e) Required group rate filings.--Each hospital plan corporation, professional health services plan corporation and HMO shall file with the department rates for accident and health insurance policies which it proposes to issue on a group, blanket or franchise basis in this Commonwealth in accordance with the following:

(1) Each hospital plan corporation, professional health services plan corporation and HMO shall establish a base rate which is not excessive, inadequate or unfairly discriminatory. The initial base rate for existing hospital plan corporations, professional health services plan corporations and HMOs shall be the rate or the rating formula currently on file and approved by the department as of February 17, 1997. The initial base rate or base rating formula for any hospital plan corporation, professional health services plan corporation or HMO with no base rate or base rating formula on file and approved as of February 17, 1997, shall be subject to filing, review and prior approval by the department.

(2) Proposed changes to an approved base rate or any approved component of an approved rating formula which effect an increase or decrease in the approved base rate or in an approved component of an approved rating formula of more than 10% annually in the aggregate shall be subject to filing, review and prior approval by the department.

(3) Proposed changes to an approved base rate or any approved component of an approved rating formula that effect an increase or decrease in the approved base rate or in an approved component of an approved rating formula of not more than 10% annually in the aggregate shall be subject to filing and review in accordance with the provisions of section 504.  1

(4) Rates developed for a specific group which do not deviate from the base rate or base rate formula by more than 15% may be used without filing with the department.

(5) Rates developed for a specific group which deviate from the base rate or base rate formula by more than 15% shall be subject to filing and review in accordance with the provisions of section 504.

(6) The commissioner shall have discretion to exempt any type or kind of rate filing under this subsection by regulation.

(f) Applicability of filings.--All filings required by this section shall be made no less than 45 days prior to their effective dates. Filings under subsection (e)(1) and (2) shall be deemed approved at the expiration of 45 days after filing unless earlier approved or disapproved by the commissioner. The commissioner, by written notice to the insurer, may within such 45-day period extend the period for approval or disapproval for an additional 45 days. All other filings under this section shall become effective as provided in section 504.

1 40 P.S. § 3801.504.
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Cite this article: FindLaw.com - Pennsylvania Statutes Title 40 P.S. Insurance § 3801.503. Required filings - last updated January 01, 2025 | https://codes.findlaw.com/pa/title-40-ps-insurance/pa-st-sect-40-3801-503/

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