Health Maintenance Organization (Pennsylvania Insurance Department regulations under the HMO Act, 40 P.S. §§ 1551 - 1567): 31 Pa. Code Chapter 301
Edition and licensing notes
Publisher. Pennsylvania Code, Insurance Department (pacodeandbulletin.gov)
Edition. Pennsylvania Code as published on pacodeandbulletin.gov, reflecting Pennsylvania Code changes effective through 56 Pa.B. 3438 (June 6, 2026)
Status. Pennsylvania Code (31 Pa.
What this document is
31 Pa. Code Chapter 301 - Health Maintenance Organization (Pennsylvania Insurance Department regulations under the HMO Act, 40 P.S. §§ 1551 - 1567) is a regulation published by Pennsylvania Code, Insurance Department (pacodeandbulletin.gov). It is one of the Pennsylvania documents that insurance license exam questions are written from, including pennsylvania life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.
Sections cited in practice questions
Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.
- 31 Pa. Code ch. 301 § 301.41 (Prohibition against uncertified HMOs)
“No corporation may solicit enrollment of members, enroll members or deliver prepaid basic health care services by, through, or in an HMO until it has received a certificate of authority to operate and maintain the HMO from the Secretary and the Commissioner.”
- 31 Pa. Code ch. 301 § 301.82 (Departmental investigation)
“(a) The Department may investigate further information contained in or forming the basis of reports submitted according to this chapter. (b) Investigation may include onsite inspection of the HMO’s facilities and records of the HMO. (c) The Commissioner or an agent shall have free access to the...”
- 31 Pa. Code ch. 301 § 301.64 (Solicitors and agents)
“Solicitors and agents for an HMO shall be licensed as, and subject to the statutes pertaining to, insurance agents.”
- 31 Pa. Code ch. 301 § 301.122 (Hold harmless)
“(Provider) hereby agrees that in no event, including, but not limited to non-payment by the HMO, HMO insolvency or breach of this agreement, shall (Provider) bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against subscriber/enrollee...”
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