reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter A - REQUIREMENTS FOR ALL POLICIES AND FORMS › PREPARATION OF FORMS › Section 89.14 - Dismemberment, death or surgical benefits

Current through Register Vol. 54, No. 28, July 13, 2024
In contracts providing specified benefits for
						dismemberment, death or surgical operations, if the insurer limits its
						liability to one such loss as a result of a single accident, the contract shall
						provide that the insured is entitled to receive the largest amount
						applicable.
The provisions of this §
													89.14 amended under sections 206,
						  506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
						  §§
														66,
						  186,
						  411 and
						  412).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter A - REQUIREMENTS FOR ALL POLICIES AND FORMS › PREPARATION OF FORMS › Section 89.15 - Simultaneous sale of insurance and equity products

Current through Register Vol. 54, No. 28, July 13, 2024
A program which contemplates the simultaneous sale of
						insurance and equity products shall be submitted to the Department for review
						in accordance with the following guidelines:
(1) The prospective purchaser shall be given
					 the option to purchase either the insurance product or the equity product
					 completely independent of one another, and shall be clearly advised to this
					 effect by the agent and in all sales material.
(2) The premium charged for the insurance
					 product shall be a separate identifiable charge and be shown as such on sales
					 material, bill, statement or draft used in connection with the
					 program.
(3) Sales material or
					 sales presentation shall separately set forth the matters pertaining to the
					 insurance product.
(4) The premium
					 rate for the insurance product may not be dependent upon the purchase of an
					 equity product, fluctuate or vary with the investment experience of an equity
					 product or vary with the amount of equity product purchased or contracted to be
					 purchased.
(5) At any time
					 subsequent to a simultaneous sale, the purchaser shall be given the right to
					 divest himself of either the insurance or the equity product.
(6) A policy, contract or related form may
					 not contain a provision which would automatically make payable insurance
					 benefits to facilitate payment of an equity product, provided that with the
					 consent of the insurer the beneficiary of the benefit may, by written
					 instruction subsequent to the time he becomes eligible for the benefit, direct
					 that all or part of the benefit be applied toward the purchase of an equity
					 product.
(7) The term equity
					 product as used herein may not include a variable annuity.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter A - REQUIREMENTS FOR ALL POLICIES AND FORMS › PREPARATION OF FORMS › Section 89.16 - Riders and endorsements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Endorsements, if printed on the form or to be applied by stamp, shall be
					 separately submitted in duplicate on the letterhead of the insurer for approval
					 or filing.
(b) "Open face" or
					 "blank" amendment forms, riders or endorsements may be used to change variable
					 or illustrative material without submission to the Department.
(c) A rider or endorsement which reduces or
					 eliminates coverage under the policy shall provide for signed acceptance by the
					 policy owner, except in the case of a rider or endorsement which is used only
					 at the time of policy issue.
(d)
					 With respect to impairment riders, a representative selection of the type of
					 fill-in material shall be shown when submitting the form. Additional or
					 alternative material which differs in fundamental approach should also be
					 submitted at the time when the material is to be used. The material may not be
					 used with forms delivered in this Commonwealth after receipt of nonacceptance
					 by the Department.
This section cited in 31 Pa. Code §
													90e.6 (relating to amendment of
						  contract).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter A - REQUIREMENTS FOR ALL POLICIES AND FORMS › PREPARATION OF FORMS › Section 89.18 - Miscellaneous requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Riot injuries.
If a policy contains an exception for injuries
					 arising out of riots, the exception should be confined to those instances in
					 which the insured is injured while participating in the riot.
(b)
Rate books.
Rate books
					 and revisions thereof should be submitted for filing. The name of the insurer
					 should appear on revision pages, supplements and the like, in order to
					 facilitate proper filing in the Department. This subsection does not apply to
					 group insurance.
The provisions of this §
													89.18 amended under sections 206,
						  506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
						  §§
														66,
						  186,
						  411 and
						  412); sections 510-514 of The
						  Insurance Company Law (40 P. S. §§
														510-514); and section 3(a) of the Accident
						  and Health Filing Reform Act (40 P. S. §
														3803(a)).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › INDIVIDUAL POLICIES › Section 89.41 - General filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Incontestable clauses.
Under sections 410 and 420C of the act
					 (40
					 P. S. §§
												510 and
					 574) the permissible
					 exclusions to the incontestable clause are clearly set forth and others are not
					 permitted. Consequently, the hazard of engaging in military or naval services,
					 except in time of war, and the hazard of aviation may not be made exclusions to
					 the incontestable clause.
(b)
					 [Reserved].
(c)
Dividends
					 payable to third parties.
If dividends are to be paid to a third
					 party, a statement shall be included showing the right of revocation of the
					 policyholder.
(d)
Special
					 premium rates.
In the case of rated policies calling for higher
					 premiums than the corresponding standard contracts, the words "Special Premium
					 Class," or a similar designation, shall be included in the brief description or
					 on the specifications page.
(e)
Work sheets.
Because of the multitude of policies with almost
					 infinite variation in nomenclature and language being submitted to the
					 Department, it is requested that companies submitting new forms for approval
					 also submit the work sheets showing the formulae for the net renewal premiums
					 and for the reserves expressed in standard actuarial symbols with all pertinent
					 data as to valuation basis, surrender charges, paid-up options and the like
					 listed. The form shall show the name of the company and its address and
					 identify the individual or firm responsible for the "certification" that the
					 methodology is consistent with the premiums and benefits provided by the
					 policy.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › INDIVIDUAL POLICIES › Section 89.43 - Accidental death benefit

Current through Register Vol. 54, No. 28, July 13, 2024
A provision for accidental death benefit may not contain
						a requirement that death must occur within a specific time
						period.
This section cited in 31 Pa. Code §
													90d.4 (relating to exclusions and
						  restrictions).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › PREMIUM FINANCING FOR COLLEGE STUDENTS › Section 89.51 - Promissory notes

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a
					 promissory note is to be executed by the insured in connection with the
					 financing of the insurance premium, this fact shall be set forth in the
					 application immediately preceding the signature of the applicant, showing the
					 amount of the note, the true rate of interest and the amount of down payment
					 made at the time of taking the application.
(b) If the insured is a minor and executes a
					 promissory note in connection with his premium payment or payments, the note
					 shall be co-signed by the parent, legal guardian or adult spouse of the
					 insured.
(c) If a promissory note
					 is executed in connection with the financing of less than the full first year's
					 premium, the balance of the premium shall be paid by the applicant at the time
					 the application is taken.
(d) A
					 down payment shall be paid by the applicant and the payment directly or
					 indirectly made by the agent under any circumstances shall be deemed a rebate
					 or inducement.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › PREMIUM FINANCING FOR COLLEGE STUDENTS › Section 89.52 - Policy provision

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 premium financing arrangement shall be fully set forth and described in the
					 policy, and a copy of a promissory note executed by the insured and an
					 assignment thereof shall be attached to the policy.
(b) A copy of an assignment of a promissory
					 note executed by the insured subsequent to the issuance of the policy and
					 copies of additional promissory notes executed by the insured subsequent to the
					 issuance of the policy shall be delivered to the insured for attachment to the
					 policy.
(c) The maximum amount of
					 premium financing arrangement which may be entered into in connection with the
					 purchase of the policy shall also be set forth in the policy, and shall be in
					 accordance with reasonable and sound underwriting practices as determined by
					 the company.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › PREMIUM FINANCING FOR COLLEGE STUDENTS › Section 89.53 - Policy receipt or acceptance form

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Upon delivery of the policy, a policy receipt or acceptance form shall be
					 executed by the insured acknowledging that:
(1) The policy has been issued as
					 presented.
(2) The insured
					 understands the provisions and obligations of the premium financing arrangement
					 and the indebtedness which he has incurred.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › PREMIUM FINANCING FOR COLLEGE STUDENTS › Section 89.54 - Sales materials

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Sales
					 materials, including promissory note forms and other forms used in the sale of
					 the insurance programs, shall be submitted to this Department with a letter of
					 transmittal at the time of submitting the policy form in question for
					 approval.
(b) Additions or
					 amendments to the materials may not be made by the company unless first
					 submitted and found acceptable to this Department.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › GROUP POLICIES › Section 89.61 - General filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Conformity to definition.
A group life policy issued for
					 delivery in this Commonwealth will not be approved by the Department which does
					 not apply to a group filing within the definition of a group qualified for the
					 insurance under the Pennsylvania Group Life Statute (40 P. S. §§
												532.1-532.9). If any element of doubt exists
					 as to whether a particular group is one authorized by the statute, the question
					 shall be referred to the Department for review in advance of filing.
(b)
Identification of insured.
Group life and annuity certificates filed with the Department shall
					 provide for the identification of the insured. This may be accomplished by
					 having the name of the insured stated on the certificate or any code which
					 could be used in the identification of the certificate holder.
(c)
Beneficiary.
Concerning
					 group life certificates, each employe insured under a form of group life
					 insurance shall be given written evidence of his beneficiary designation, if
					 any.
(d)
Variations in
					 policies.
Group life policies, their certificates and the intended
					 insert pages reflecting possible variations shall be accepted for approval,
					 provided that the filing is accompanied by a statement showing the combinations
					 of pages which will be used for the different types of policies.
(e)
Dependent policies.
Dependent group life is not permissible.
(f)
Certificates.
Certificates shall conform with all of the following:
(1) Certificates shall be issued to the
					 policy owner within a reasonable period of time after issuance of the master
					 policy for delivery to each person insured.
(2) Certifying language shall be used in
					 certificates.
(3) Certificates
					 should state the benefits applicable to the person insured or state the
					 schedule of benefits applicable to the class to which he belongs.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter B - REQUIREMENTS FOR LIFE INSURANCE › GROUP POLICIES › Section 89.62 - Group annuity policies and forms

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Variable annuities shall conform with Chapter 85 (relating to variable annuity
					 and variable accumulation annuity contracts).
(b) A group annuity master policy should
					 state the type of an annuity funding plan used, such as regular deferred,
					 deposit administration, separate account and the like.
(c) A statement concerning the availability
					 of optional modes of settlement shall appear in the certificates as well as in
					 the master policy.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.71 - General

Current through Register Vol. 54, No. 28, July 13, 2024
Submissions shall comply with sections 616-621 of the act
						(40
						P. S. §§
												751-756). The NAIC
						Official Guide for the Filing and Approval of A & H Contracts (3rd Edition)
						shall serve as a general guide for review in the Department, except to the
						extent that the guide is inconsistent with the laws of the
						Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.72 - Applications

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Opinion-type
					 questions regarding the past or present health of the applicant should provide
					 that the applicant is to answer to the best of his knowledge and
					 belief.
(b) A provision may not be
					 permitted in an application which changes the terms of the policy to which it
					 is attached.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.73 - Required statements in policies

Current through Register Vol. 54, No. 28, July 13, 2024
(a) There shall be imprinted on the face of
					 the policy the "Notice of Insured's Right to Examine Policy for Ten Days," as
					 required by section 617 of the act (40 P. S. §
												752). The provision shall be worded that the
					 insured is given the option for a full refund. On booklet-type policies this
					 provision shall appear on the outside cover portion of the policy.
(b) The words "This Is An Assessable Policy"
					 shall be printed prominently on the policy face and filing back, if any, of
					 each assessable policy in at least 16-point type.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.74 - Renewability and cancellation of policies

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Provisions concerning renewability or
					 cancellation by the insurer shall appear on the first page or reference shall
					 be made thereto in a brief description on the face page and on the filing back,
					 if any.
(b) Policies which are
					 noncancellable and guaranteed renewable shall state clearly the period of time
					 during which they are to be guaranteed renewable and shall provide that the
					 company cannot cancel the policy and that the company cannot increase the
					 premium.
(c) Nonrenewal of
					 individual accident and health policies may not be based upon deterioration of
					 physical or mental health.
(d)
					 Policy nonrenewal should also be limited to the anniversary date.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.75 - Use of certain words and terms

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 policy containing, as part of its title, words such as "special" or "preferred"
					 which are used in a misleading fashion, or words such as "Union," "Labor,"
					 "Miner," and the like in its title which could associate it with a particular
					 organization, association or business will not be approved.
(b) Policies which are to be issued to
					 supplement or implement Medicare may not have policy titles or headings which
					 could confuse them with the Federal Medicare Program.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.76 - Suspension and termination

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 policy may not contain a provision for its automatic termination upon the
					 happening of any loss, except a loss which has exhausted all possible benefits
					 under the policy.
(b) A policy
					 which provides for a suspension of coverage while the insured is in military
					 service the policy shall provide that upon written request the insurer will
					 refund unearned premiums for the period of the suspension.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.77 - Exclusions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The following
					 is a list of the maximum applicable exclusions which shall be permitted in
					 addition to those specified under section 618 of the act (40 P. S. §
												753). The wording of the exclusions is
					 illustrative and is intended to indicate the general intent of the Department.
					 Alternate wording is permissible as long as the meaning preserves the general
					 intent of the exclusions:
(1)
General
					 exclusions.
General exclusions shall conform with the following:
(i) Loss sustained or expenses incurred while
					 a member of the armed forces of any nation, or losses sustained or expenses
					 incurred as a result of enemy action or act of war whether declared or
					 undeclared.
(ii) Normal pregnancy,
					 childbirth, miscarriage and abortion.
(iii) Suicide or intentionally self-inflicted
					 injuries.
(iv) Sickness or injury
					 covered by a workmen's compensation act or occupational disease law or by
					 United States Longshoreman's and Harbor Worker's Compensation Act.
(v) Mental or nervous or emotional
					 disorders.
(vi) Exclusions which,
					 in the opinion of the Commissioner, are justified by special circumstances or
					 the unique character of the policy.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.78 - Multiple benefits

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Policies which contain multiple benefits should not limit the payment of a
					 specific benefit based on the fact that another benefit is paid under the same
					 policy.
(b) Examples of the
					 policies that the Department considers unacceptable are policies containing
					 both disability income benefits and hospital or other medical care benefits in
					 which payment of hospital or medical care benefits is excluded if disability
					 income is payable, policies which contain accidental death benefits and medical
					 care or disability benefits which limit the benefit payable to one of the two
					 benefits, policies which contain lump sum dismemberment benefits which are paid
					 in lieu of disability income or medical expenses benefits.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.79 - Accident policies not providing coverage for sickness

Current through Register Vol. 54, No. 28, July 13, 2024
In accident only policies, continuous 24-hour coverage as
						well as all causes should be provided.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.80 - Loss of time benefits

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Loss of
					 time policies may not require that the loss from accidental injury commence
					 within less than 30 days after the date of an accident, nor may the accident
					 policy which the insurer may cancel or refuse to renew require that it be in
					 force at the time the loss commences.
(b) A policy of health and accident insurance
					 will not be approved which contains a provision that the disability period
					 shall be considered to commence with the date on which written notice is
					 actually received by the company.
(c) Policies which limit benefits for loss of
					 time to specified items, such as business overhead policies, shall provide for
					 a premium refund in accordance with a short rate table in the event that none
					 of the items to be indemnified exist at the time the policy is cancelled, for
					 example, where a professional person discontinues his office, but only if the
					 insured requests cancellation of the policy and gives timely notice. A premium
					 refund may be limited to 1 year's premium.
(d) The definition of total disability should
					 be sufficiently clear so as not to confuse or mislead the insured. Wording in
					 the definition of total disability should be that claim administration will be
					 uniform as possible and the coverage is in the best interests of the insurance
					 buying public.
(e) A provision for
					 accidental death benefit may not contain a requirement that death must occur
					 within a specific time period.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.81 - Riders and endorsements

Current through Register Vol. 54, No. 28, July 13, 2024
Transfer riders which eliminate waiting periods in time
						limit on certain defenses or preexisting conditions may be approved for an
						exchange of policies within a company or affiliated companies but not in
						transfer from one company to another.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.82 - Miscellaneous policy provisions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 If the policy provides for a reduction in benefits because of the attainment of
					 a specified age limit, reference thereto shall be set forth on the first or
					 specifications page. For this purpose, a reduction in a benefit period is a
					 reduction in benefits requiring such reference.
(b) Policies shall comply with section 617 of
					 the act (40 P. S. §
												752),
					 providing for the continuation of coverage for mentally retarded and physically
					 handicapped dependents.
(c) A
					 policy which contains a disability income benefit or a similar type benefit may
					 not require an insured person to be confined to his residence due to sickness
					 or injury as a condition for the benefit, a change in the amount of the benefit
					 or a change in duration of coverage of the benefit.
(d) A reduction of benefits by reason of a
					 change in employment status or change in income of the insured may be
					 permitted, unless clearly set forth in the policy under an appropriate
					 caption.
(e) Dependency status may
					 not be defined by sex.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.83 - Rates

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
General.
Accident and health insurance rate filings will be
					 examined for actuarial adequacy, consistency and equity, including
					 nondiscrimination aspects. Data required should be broken down by the type of
					 filing as prescribed in subsections (b) and (c). The Department will consider
					 in its rate review, along with other pertinent data, the loss ratios submitted
					 by companies as anticipated to be accumulated over the entire period of
					 coverage.
(b)
New
					 filings.
New filings shall conform with all of the following:
Type
Percentage
Industrial policies
45
All other policies
50
(1) With
					 regard to rates for policies which are initially filed for approval, the
					 Department will not consider acceptable anticipated loss ratios which are lower
					 than the following levels:
(2) The
					 company shall maintain its records in a condition that loss ratios may be
					 traced on a closed block basis for each calendar year, thus yielding durational
					 loss ratios relative to a given calendar year of underwriting.
(3) New filings shall also conform with all
					 of the following:
(i) An actuarial memorandum
					 shall be submitted describing how premium rates were computed. The memorandum
					 shall include suitable data indicating the basis for the rates, such as the
					 expected claim costs, the tables or experience, if any, upon which the rates
					 have been based, and an explanation of how the premium rates were
					 obtained.
(ii) If modifications
					 have been based on judgment, this should be indicated as well as any other
					 relevant information which the company considers appropriate.
(iii) Rates shall be adequate but not
					 excessive, provide for internal equity, and be consistent with rates for any
					 concurrent coverage available.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.84 - Discrimination prohibited

Current through Register Vol. 54, No. 28, July 13, 2024
No discrimination in availability of policy forms or
						other restrictions or limitations in underwriting practices or eligibility
						standards are permitted on the basis of race, religion, nationality or ethnic
						group, age, sex, family size, occupation, place of residence or marital status
						in accordance with section 5(a)(7)(III) of the Unfair Insurance Practices Act
						(40
						P. S. §
												1171.5(a)(7)(III)) and PA.
						CONST. art. I, § 7.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › INDIVIDUAL POLICIES › Section 89.85 - Severability

Current through Register Vol. 54, No. 28, July 13, 2024
If a provision of this chapter or the application thereof
						to a person is held invalid, the remainder of the chapter and the application
						of the provision to other persons will not be affected
						thereby.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.91 - General filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Conformity to definition.
A group life policy issued for
					 delivery in this Commonwealth will not be approved by the Department which does
					 not apply to a group filing within the definition of a group qualified for the
					 insurance under the act of May 11, 1949 (P. L. 1210, No. 367) (40 P. S.
					 §§
												532.1-532.7a), known as the
					 Group Life Insurance Policy Laws. If an element of doubt exists as to whether a
					 particular group is one authorized by the statute, the question shall be
					 referred to the Department for review in advance of filing.
(b)
Identification of
					 insured.
Group life and annuity certificates filed with the Department
					 shall provide for the identification of the insured. This may be accomplished
					 by having the name of the insured stated on the certificate or a code which
					 could be used in the identification of the certificate holder.
(c)
Variations in policies.
Group life policies, their certificates and the intended insert pages
					 reflecting possible variations shall be accepted for approval, provided that
					 the filing is accompanied by a statement showing the combinations of pages
					 which shall be used for the different types of policies.
(d)
Certificates.
Certificates shall conform with all of the following:
(1) Certificates shall be issued to the
					 policy owner within a reasonable period of time after issuance of the master
					 policy for delivery to each person insured.
(2) Certifying language shall be used in
					 certificates.
(3) Certificates
					 should state the benefits applicable to the person insured or state the
					 schedule of benefits applicable to the class to which he belongs.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.92 - Use of certain words and terms

Current through Register Vol. 54, No. 28, July 13, 2024
Policies which are to be issued to supplement or
						implement Medicare may not have policy titles or headings which could confuse
						them with the Federal Medicare Program.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.93 - Termination of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Master
					 policies, riders and certificates shall contain a clear explanation as to
					 continuance of that coverage after termination of the policy. In the case of
					 maternity benefits, the policy shall clearly define the circumstances under
					 which the coverage ceases and whether the insurer intends to include a
					 pregnancy coverage for 9 months after the policy has expired or whether the
					 coverage ceases with the expiration of the remainder of the policy.
(b) A group accident and health policy may
					 not contain a provision for automatic termination of the coverage of an
					 individual upon the happening of a loss, except a loss which has exhausted all
					 possible benefits under the policy.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.94 - Exclusions

Current through Register Vol. 54, No. 28, July 13, 2024
Exclusions which are ambiguous or unfairly discriminatory
						are not acceptable.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.95 - Loss of time benefits

Current through Register Vol. 54, No. 28, July 13, 2024
Loss of time benefits for dependents are not
						acceptable.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.96 - Certificates

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Certifying
					 language shall be used in certificates.
(b) Certificates shall be issued to the
					 policy owner within a reasonable period of time after the effective date of the
					 master policy for delivery to each person insured. Certificates should state
					 the benefits applicable to the person insured or state the schedule of benefits
					 applicable to the class to which he belongs.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.97 - Miscellaneous policy provisions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Conformity with definition of a group.
A group policy of
					 insurance approved by the Department will not be issued for delivery in this
					 Commonwealth by an insurer to a group which does not come within the definition
					 of a group qualified for the insurance.
(b)
Variations in policies.
Because of the many variations possible in group accident and health policies,
					 the policies, their certificates and the intended insert pages reflecting
					 possible variations will be accepted for approval, provided that the filing is
					 accompanied by a statement showing the combination of pages which will be used
					 for different types of policies.
(c)
Coordination with other plans.
Nonduplication or coordination of benefit provisions for group
					 medical expense insurance coverages may provide for nonduplication or
					 coordination with a plan or State or Federal program providing benefits or
					 services for or by reason of medical or dental care and treatment which
					 benefits or services are provided by group insurance or another arrangement of
					 coverage of persons in a group whether on an insured or uninsured basis.
					 Policies with these provisions shall stipulate clearly how the provisions will
					 be administered.
(d)
Accidental death benefit.
A provision for accidental death
					 benefit may not contain a requirement that death must occur within a specific
					 time period.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.97a - Maternity benefits in group converted policies- statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Section 621.2
					 of the act (40 P. S. §
												756.2(d)) mandates that
					 every group accident and sickness policy providing hospital, surgical or major
					 medical expense coverage contain a conversion privilege. The converted policy
					 may not contain provisions less favorable to the insured than the group
					 policy.
(b) An insurer shall offer
					 a converted policy which includes maternity coverage whenever the group policy
					 contains the coverage. Insurers not offering maternity benefits in converted
					 policies under these circumstances are in violation of Commonwealth law and
					 shall make form and rate filings necessary to comply.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.98 - Major medical

Current through Register Vol. 54, No. 28, July 13, 2024
In the event of termination of insurance because of
						termination of active employment, a reasonable extended benefit should be
						provided during total disability, with respect to the sickness or injury which
						caused the disability, of at least 12 months subsequent to termination of
						insurance, unless coverage is afforded for total disability under another group
						plan.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter C - REQUIREMENTS FOR ACCIDENT AND HEALTH INSURANCE › GROUP POLICIES › Section 89.99 - Student accident and sickness insurance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An application, enrollment form, policy,
					 certificate or brochure used in lieu of a certificate, rider or endorsement may
					 not be used, sold or issued until the forms of the same have been filed with
					 and approved by the Insurance Commissioner.
(b) Applicable premium rates shall be filed
					 with the Department.
(c) The
					 insurer shall make known to every individual purchaser the applicable schedule
					 of benefits, premium rates and claim filing procedures and advise where
					 additional information and assistance relating to the benefits, rates and
					 procedures may be obtained.
(d)
					 Certificate or brochure used in lieu of a certificate shall set forth the
					 essential features of the coverage, location of the claims office and
					 instructions for filing claims and it shall be delivered or furnished for
					 delivery to the individual purchaser.
(e) A provision excluding, limiting or
					 coordinating benefits by reason of other insurance shall be set forth clearly
					 in the policy, be accurately summarized in a certificate or brochure used in
					 lieu of a certificate and in advertising material, and not be applied to the
					 first $100 of any one claim.
(f)
					 Prior to its initial use, material used in the direct solicitation of student
					 accident insurance shall be submitted to the Department for review. Within 30
					 days from the date that the material is received by the Department, the insurer
					 will be notified whether or not the Department has an objection to the same.
					 Thereafter, amended material shall be promptly submitted to the Department;
					 however, review prior to use will be required only in the event of substantial
					 change.
(g) Advertising material
					 and direct solicitation material prepared by an agent or broker shall be
					 approved by the insurer prior to use. Material which differs substantially from
					 that already submitted by the insurer to the Department for review shall be
					 submitted under subsection (f).
(h)
					 The insurer shall require an enrollment form to be signed by the parents,
					 guardian or person in loco parentis of each student, except in the case of
					 married or adult students, or where the participant is not required to make a
					 premium contribution.
(i) An
					 individual application or enrollment form shall clearly indicate that there is
					 no obligation to purchase the insurance.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter D - ADDITIONAL REQUIREMENTS FOR FRATERNAL BENEFIT SOCIETIES › Section 89.101 - Prior approval of forms required

Current through Register Vol. 54, No. 28, July 13, 2024
Under
					 40 Pa.C.S. §
											6529(c) (relating to
					 beneficiary certificates), it is unlawful for a fraternal benefit society to
					 issue, sell or dispose of a certificate or contract providing benefits to its
					 membership in this Commonwealth or use applications, riders or endorsements in
					 connection therewith, until the forms thereof have been submitted to and
					 approved by the Department.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter D - ADDITIONAL REQUIREMENTS FOR FRATERNAL BENEFIT SOCIETIES › Section 89.102 - Guidelines for approval of forms

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
General filing requirements.
Fraternal benefit society filings
				  shall comply with the requirements and procedures of Subchapters A-C (relating
				  to requirements for all policies and forms; requirements for life insurance;
				  and requirements for accident and health insurance) except where these
				  requirements and procedures are not applicable.
(b)
General conditions of approval.
General conditions of approval shall conform with the following:
(1) An approved form may not be used to
				  insure anyone who is not a member or a spouse or dependent of a member of the
				  fraternal benefit society as required by section 301(b) of the Fraternal
				  Benefit Society Code (40 P. S. §
												1141-301(b)). Nor may an
				  approved form be used to insure a juvenile except upon the application of an
				  adult as required by section 302(a) of the Fraternal Benefit Society Code
				  (40
				  P. S. §
												1141-302(a)).
(2) [Reserved].
(3) Forms can contain words such as
				  insurance, insured, premium, policy and other type words usually associated
				  with commercial insurance. In lieu thereof, words such as benefit, member,
				  dues, certificate and the like type may be used. However, the type of wording
				  used in forms shall be consistent. This is not intended to prohibit the use of
				  words to describe different things as long as the wording used in the form is
				  consistent.
(4) Approvals are
				  conditioned upon the forms being used lawfully, and in conformity with
				  applicable rules and regulations of the Department.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter D - ADDITIONAL REQUIREMENTS FOR FRATERNAL BENEFIT SOCIETIES › Section 89.103 - Advertising

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Advertising
				  used in connection with approved forms shall prominently disclose that the
				  insurance is available only to members, their spouses and dependents, or to
				  juveniles.
(b) The insurance
				  solicitation shall be segregated from the membership solicitation in
				  advertising simultaneously soliciting insurance and membership.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter D - ADDITIONAL REQUIREMENTS FOR FRATERNAL BENEFIT SOCIETIES › Section 89.104 - Charter, bylaws and rate books

Current through Register Vol. 54, No. 28, July 13, 2024
A certified and current copy of the charter and bylaws of
					 the society and rate book shall be filed with the Bureau of Regulation of Rates
					 and Policies.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter F - COVERAGE FOR NEWBORN CHILDREN › Section 89.201 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
Act 81
-The act of August 1, 1975 (P. L.
					 157, No. 81) (40 P. S. §§
											753.1-753.4).
Coverage for newborn children
-The same
					 coverage provided under the terms of the form for dependent children for
					 sickness, disease or injury. If the form does not provide coverage for
					 dependent children, the coverage shall be the same as that provided the insured
					 or subscriber. For purposes of compliance with Act 81, injury or sickness shall
					 include medically diagnosed congenital defects, birth abnormalities,
					 prematurity and routine nursery care. If the form provides coverage for routine
					 well baby care, the same coverage shall be provided for newborn children. The
					 coverage shall be provided regardless of whether the form provides for
					 obstetrical coverage.
Insured or subscriber
-A person, male or
					 female, covered under the terms of a form to which Act 81 is applicable,
					 regardless of the covered person's marital or dependency status or eligibility
					 for maternity benefits.
Routine nursery care
-Hospital or other
					 qualified health care institution, room, board or miscellaneous institutional
					 care or care rendered by a licensed medical practitioner, performing within the
					 scope of his license, associated with hospital confinement.
Routine well-baby care
-Expense for which
					 coverage is available under a form to a covered person for preventive health
					 care, rendered either on an inpatient or outpatient basis, not associated with
					 treatment of an ill or injured person, such as, but not limited to,
					 immunizations, medical examinations or tests not necessary for the treatment of
					 covered injuries, illnesses, birth defects, deformities or diseases, and
					 hospital room, board or miscellaneous institutional expenses.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter F - COVERAGE FOR NEWBORN CHILDREN › Section 89.202 - Forms which need not provide newborn coverage

Current through Register Vol. 54, No. 28, July 13, 2024
Forms of insurers, other than hospital plan corporations,
					 professional health service plan corporations, fraternal benefit societies and
					 voluntary nonprofit health service plans, providing benefits on an indemnity
					 basis, for example, payment on a specified amount without regard to actual
					 expense incurred, need not provide coverage for newborn
					 children.