HMO Initial Licensing Application Process and Related Appendices
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HMO Application Process
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Appendix 1 HMO Act (40 P.S. 1551-1568)
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Appendix 1.1 HMO Act Amendments
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Appendix 2 Department of Health HMO Regulations
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Appendix 3 Insurance Department HMO Regulations
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Appendix 4 Insurance Department Accident and Health Filing Reform Act (40 P.S. 3801-3815)
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Appendix 5 Certificate of Authority Application Cover Sheet
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Appendix 6 Crosswalk Forms for Department of Health Requirements
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Appendix 7 Insurance Department Checklist - Guidelines/Technical Advice Regarding Health Insurance Forms
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Appendix 8 Guidelines/Technical Advice in Developing Provider Contracts
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Appendix 9 Insurance Department List of Mandated Health Insurance Benefits
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Appendix 10 Department of Health and Insurance Department Statements of Policy on Integrated Delivery Systems
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Appendix 11 Department of Health Advisory Regarding HMO Contracting to Serve Medical Assistance Patients
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Appendix 12 Department of Health Technical Advisory Regarding Exemption Requests for CRNPs to Serve as Primary Care Providers
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Appendix 13 Guidelines, Procedures and Regulations for Developing a Member Grievance System
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Appendix 14 Guidelines/Technical Advice in Developing a Quality Assurance Plan
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Appendix 15 Guidelines for Developing Credentialing System
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Appendix 16 General Outline and Agenda for Department of Health On-Site Review
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Appendix 17 Department of Health HMO Quarterly and Annual Reporting Instructions and Forms
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Appendix 18 Department of Health and Insurance Department Joint Policy Statement - HMO Point-of-Service Products and Gatekeeper PPOs
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Appendix 19 Insurance Department Memo Regarding Minimum Capital and Surplus Requirements for Licensure of HMOs
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Appendix 20 Insurance Department Guidelines/Technical Advice Regarding the Development of a Business Plan for Newly Formed HMOs
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Appendix 21 Insurance Department Guidelines/Technical Advice Regarding Rates
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Appendix 22 General Outline and Agenda for Insurance Department Organizational Exam
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Appendix 23 Department of Health List of Approved External Quality Review Organizations
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Appendix 24 Department of Health List and Insurance Department Service Area Expansion Guidelines
Need Help?
Questions regarding specific applications should be addressed to ra-in-companylicense@pa.gov or 717-787-2735.