An Act amending the act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act, further providing for rules and regulations.

Summary

The bill changes Pennsylvania’s Health Maintenance Organization Act so that the Insurance Commissioner and Health Secretary must adopt rules, within one year, that stop HMOs from refusing payment for covered basic or physician services just because the referral was made by a direct primary care provider who isn’t in the HMO’s network. It affects all HMOs, their members, and direct primary care providers, aiming to protect patients who use direct‑care agreements.

AI-generated summary — may be incomplete or inaccurate. Verify against the official bill text.

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