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of the Commonwealth of Pennsylvania

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    List of Appendices

    Appendix 01HMO Act (40 P.S. 1551-1568)
    Appendix 02Department of Health HMO Regulations
    Appendix 03Insurance Department HMO Regulations
    Appendix 04Insurance Department Accident and Health Filing Reform Act (40 P.S. 3801-3815)
    Appendix 05Certificate of Authority Application Cover Sheet
    Appendix 06Crosswalk Forms for Department of Health Requirements
    Appendix 07Insurance Department Checklist - Guidelines/Technical Advice Regarding Health Insurance Forms
    Appendix 08Guidelines/Technical Advice in Developing Provider Contracts
    Appendix 09Insurance Department List of Mandated Health Insurance Benefits
    Appendix 10Department of Health and Insurance Department Statements of Policy on Integrated Delivery Systems
    Appendix 11Department of Health Advisory Regarding HMO Contracting to Serve Medical Assistance Patients
    Appendix 12Department of Health Technical Advisory Regarding Exemption Requests for CRNPs to Serve as Primary Care Providers
    Appendix 13Guidelines, Procedures and Regulations for Developing a Member Grievance System
    Appendix 14Guidelines/Technical Advice in Developing a Quality Assurance Plan
    Appendix 15Guidelines for Developing Credentialing System
    Appendix 16General Outline and Agenda for Department of Health On-Site Review
    Appendix 17Department of Health HMO Quarterly and Annual Reporting Instructions and Forms
    Appendix 18Department of Health and Insurance Department Joint Policy Statement - HMO Point-of-Service Products and Gatekeeper PPOs
    Appendix 19Insurance Department Memo Regarding Minimum Capital and Surplus Requirements for Licensure of HMOs
    Appendix 20Insurance Department Guidelines/Technical Advice Regarding the Development of a Business Plan for Newly Formed HMOs
    Appendix 21Insurance Department Guidelines/Technical Advice Regarding Rates
    Appendix 22General Outline and Agenda for Insurance Department Organizational Exam
    Appendix 23Department of Health List of Approved External Quality Review Organizations
    Appendix 24Department of Health List and Insurance Department Service Area Expansion Guidelines

    Questions regarding specific applications should be addressed to ra-in-companylicense@pa.gov or 717-787-2735.