2012 Pennsylvania Consolidated Statutes
Title 40 - INSURANCE
Chapter 63 - Professional Health Services Plan Corporations
Section 6325 - Income status; effect

     § 6325.  Income status; effect.
        (a)  Income standards.--
            (1)  Every professional health service corporation shall
        from time to time, by action of its members, fix the
        requisites for persons of low income eligible for the
        benefits of and under this chapter, such requisites to afford
        due consideration to the marital status and to the number of
        dependents of the persons involved and such requisites to be
        consistent with the declaration contained in section 6303(a)
        of this title (relating to declaration of necessity). Any
        requisites thus fixed shall be subject to the approval of the
        department.
            (2)  All persons not meeting the requisites for persons
        of low income as thus fixed shall be persons of over-income.
        (b)  Determination of status.--
            (1)  The professional health service corporation shall
        determine whether an applicant for subscription is in receipt
        of a low income or over-income within the meaning of this
        chapter and after the application has been approved, the
        subscriber shall be deemed to be of low income or over-income
        until his status has been redetermined by the corporation,
        which redetermination may be made at any time.
            (2)  The professional health service corporation, in
        determining the income status of any applicant or subscriber,
        may, through its officers and agents, examine under oath any
        applicant or subscriber claiming a low income status and any
        other person consenting thereto who is believed to have
        material knowledge concerning the income status of the
        applicant or subscriber. The determination of the corporation
        shall be final.
        (c)  Effect of status.--Every person of low income and every
     person of over-income, residing in the area served by a
     professional health service corporation, shall be entitled, upon
     complying with regulations adopted by that corporation and the
     payment of such initiation and other fees as are authorized by
     the department, to the services of any health service doctor
     registered with the corporation, under such terms and conditions
     as are customary in professional health services in the
     community, but only within the limits of services for which such
     health service doctors are registered. A professional health
     service corporation may for cause refuse to enter into
     contractual relations with an applicant and may, for cause,
     after due notice and opportunity for hearing, rescind any
     contract that it has entered into with any subscriber and refund
     any unearned portion of any fees paid and may, on default in
     payment of the agreed dues, fees, payments or any charges by
     subscriber or someone on his behalf, discontinue coverage
     without notice and opportunity for hearing, after having
     notified a subscriber of his default, and having allowed him two
     days to procure such coverages. Any payment made by the
     corporation to health service doctors for services rendered to
     subscribers of over-income shall be a payment only to the extent
     agreed upon between the corporation and the health service
     doctors on account of any greater sum which may be due the
     health service doctors for rendering such services.
        (d)  Prohibited contracts.--No contract by or on behalf of
     any professional health service corporation shall provide for
     any periodic payment or any other payment by that corporation to
     a subscriber which is not related to the value of the service
     provided to such subscriber on account of illness or injury, nor
     be in any way related to the payment of any such benefit by any
     other entity.

        Cross References.  Section 6325 is referred to in section
     6302 of this title.