CHAPTER 63
PROFESSIONAL HEALTH SERVICES PLAN
CORPORATIONS
Subchapter
A. Preliminary Provisions and Certification
B. Regulation Generally
Enactment. Chapter 63 was added November 15, 1972, P.L.1063, No.271, effective in 90 days.
2022 Partial Repeal. Section 11(2)(iv) of Act 146 of 2022 provided that Chapter 63 is repealed insofar
as it is inconsistent with Act 146.
Cross References. Chapter 63 is referred to in sections 3802, 3902, 4001, 4302, 4502, 4802, 4901, 5002,
5101, 9103 of this title; section 4117 of Title 18 (Crimes and Offenses); sections
4304.1, 4326 of Title 23 (Domestic Relations); sections 3302, 3303 of Title 35 (Health
and Safety); section 6160 of Title 42 (Judiciary and Judicial Procedure); section
7309 of Title 51 (Military Affairs); section 1719 of Title 75 (Vehicles).
SUBCHAPTER A
PRELIMINARY PROVISIONS AND CERTIFICATION
Sec.
6301. Application of chapter.
6302. Definitions.
6303. Statement of legislative findings and policy.
6304. Certification of professional health service corporations.
6305. Initial reserves.
6306. Standards concerning incorporators.
6307. Exemptions applicable to certificated professional health service corporations.
6308. Uncertificated plans prohibited.
6309. Penalties.
6310. Enforcement.
§ 6301. Application of chapter.
(a) General rule.--This chapter shall apply to every person engaged in the business of maintaining and
operating a nonprofit health service plan and to every person who shall violate any
provision of this chapter.
(b) Exceptions.--Notwithstanding subsection (a) of this section, this chapter shall not apply to:
(1) Any hospital plan corporations as defined in section 6101 of this title (relating
to hospital plan corporation definitions).
(2) Any fraternal benefit society subject to regulation under Chapter 65 of this title
(relating to fraternal benefit societies).
References in Text. Chapter 65, referred to in this section, is repealed. The subject matter is now contained
in Article XXIV of the act of May 17, 1921, P.L.682, No.284, known as The Insurance
Company Law of 1921.
Notes of Decisions
Pennsylvania Dental Ass'n v. Commonwealth Ins. Dep't, 516 A.2d 647 (Pa. 1986).
· cites it 2× “As such, it is regulated by the Professional Health Service Plan Corporations Act, 40 Pa.C.S. §§ 6301, et seq., which is administered by Appellee, the Pennsylvania Insurance Department (hereinafter the "Department" or the "Insurance Department").”
Rudolph v. Pennsylvania Blue Shield, 717 A.2d 508 (Pa. 1998).
· cites it 4× “Pursuant to the Pennsylvania Health Services Plan Corporations Act, 40 Pa.C.S. § 6301 et seq. and the contract entered into between the doctor and Blue Shield, the doctor submitted his claim to a medical review committee appointed by Blue Shield.”
Kilmore v. Erie Ins., 595 A.2d 623 (Pa. Super. Ct. 1991).
“" Blue Shield technically is not an “insurance company” under Pennsylvania law, but rather a "general medical service corporation” operating “nonprofit professional health service plans,” and statutorily regulated by the Professional Health Services Plan Corporation Act, 40…”
Philadelphia Cnty. Med. Soc'y v. Kaiser, 699 A.2d 800 (Pa. Commw. Ct. 1997).
“1063, as amended, 40 Pa.C.S. §§ 6301 — 6335. . The Consolidating Companies requested an exemption from the filing requirements of what is commonly known as the Insurance Holding Companies Act, Act of May 17, 1921, P.”
Apple v. Commonwealth, Dep't of Ins., 431 A.2d 1183 (Pa. Commw. Ct. 1981).
“1063, as amended, 40 Pa. C. S. §6301, seeks to insure adequate professional health services for low-income persons while the Unfair Insurance Practices Act (UIPA), Act of July 22, 1974, P.”
Rudolph v. Pennsylvania Blue Shield, 679 A.2d 805 (Pa. Super. Ct. 1996).
“*807 Thus, the issue in this case, apparently one of first impression in the appellate courts of Pennsylvania, requires us to determine the proper scope of judicial review, if any, following an award by a professional health corporation’s review committee established pursuant to…”
Pennsylvania Dental Ass'n v. Med. Serv. ASS'N, 632 F. Supp. 653 (M.D. Penn. 1986).
“The Pennsylvania Insurance and Health Departments regulate Blue Shield pursuant to the Professional Health Service Corporation Act, 40 Pa.C.S. § 6301 et seq., as amended (the Blue Shield Regulatory Act).”
Pennsylvania Blue Shield v. Commonwealth, 520 A.2d 92 (Pa. Commw. Ct. 1987).
“…based upon the kind of service provided in the separate agreements. I would reverse the Commissioners ruling. 40 Pa. C. S. §§6301 — 6335.”
Donovan v. Pennsylvania Blue Shield, 20 Pa. D. & C.4th 496 (1992).
· cites it 2× “Defendant, Pennsylvania Blue Shield, is a professional health services plan corporation governed by, inter alia, 40 Pa.C.S. §6301 *497 et seq. It sells medical insurance that provides indemnity to cover patient’s bills for medical services rendered by “participating physicians.”
Tabib v. Highmark Inc., 77 Pa. D. & C.4th 171 (2005).
“(citation omitted) Medical Review Committees such as that of the defendant, are statutorily governed by the Pennsylvania Professional Health Services Plan Corporations Act, 40 Pa.C.S. §6301 etseq. Regarding the rights of doctors in a health service plan, the Act provides: “40 Pa.”
Pennsylvania Dental Ass'n v. Med. Serv. Ass'n, 32 Pa. D. & C.3d 380 (1982).
“Plaintiffs also added serveral paragraphs alleging that PBS’s use of “profiles” (mathematically calculated scales), to determine the fee PBS will pay to dentists for services violates the above-mentioned sections of the Regulatory Act of November 15, 1972, 40 Pa.C.S. §6301 et…”
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