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§ 991.2164. Internal adverse benefit determination process for insurer

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: January 1, 2024

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 2. Insurance Companies (Refs & Annos)
Article XXI. Quality Health Care Accountability and Protection (Refs & Annos)
(I.1) Adverse Benefit Determinations
Effective: January 1, 2024
40 P.S. § 991.2164
§ 991.2164. Internal adverse benefit determination process for insurer
(a) Determination process.--An insurer shall establish and maintain an internal adverse benefit determination process that complies with section 2719 of the Public Health Service Act (58 Stat. 682, 42 U.S.C. § 300gg-19) and regulations promulgated under the Public Health Service Act.
(b) Notice.--Following an adverse benefit determination and prior to any appeal of an adverse benefit determination under subsection (a), an insurer shall provide a covered person or covered person's authorized representative notice of the covered person's right to appeal an adverse benefit determination which shall be in a form approved by the department.

Credits

1921, May 17, P.L. 682, No. 284, § 2164, added 2022, Nov. 3, P.L. 2068, No. 146, § 7, effective Jan. 1, 2024.
40 P.S. § 991.2164, PA ST 40 P.S. § 991.2164
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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