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HMO Application

**PLEASE NOTE – As of Jan. 1, 2021, via Memorandum of Understanding between the Department of Health (DOH) and the Insurance Department (PID), the Bureau of Managed Care has moved from DOH to PID.  The HMO Application has not yet been updated to reflect this change.  Questions regarding specific applications should be addressed to or 717-787-2735 and or 717-787-4192.  


List of Appendices:

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