reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › DEFINITION OF TERMS › Section 88.142 - Debit plan policies

Current through Register Vol. 54, No. 28, July 13, 2024
These policies are those which are issued on a weekly
					 premium paying basis and in which the premiums are collectible weekly by an
					 agent of the insurance company.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › DEFINITION OF TERMS › Section 88.143 - One period of confinement

Current through Register Vol. 54, No. 28, July 13, 2024
One period of confinement means one or more separate or
					 combined periods of confinement in a hospital, for the same or related causes
					 not separated by an interval of at least 6-consecutive months between the end
					 of one such period and the beginning of the succeeding period. When succeeding
					 confinements for the same or related causes are separated by such a 6-month
					 interval, the second confinement will be considered a new period of confinement
					 and any applicable benefit limits will be restored.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › CONVERSION PRIVILEGES › Section 88.151 - Compliance

Current through Register Vol. 54, No. 28, July 13, 2024
If a policy contains a conversion privilege, it shall
					 comply, in substance, with the following:
(1) The caption of the provision shall be
				  "Conversion Privilege," or words of similar import. The provision shall
				  indicate the persons eligible for conversion. The circumstances applicable to
				  the conversion privilege, including any limitations on the conversion, and the
				  person by whom the conversion privilege may be exercised, shall be described in
				  the provision. The provision may indicate that the privilege is subject to the
				  underwriting standards of the insurer relating to overinsurance.
(2) A business overhead expense policy issued
				  on a guaranteed renewable basis, on a noncancellable basis, or a renewable at
				  the option of the insurer basis may, at the option of the insurer, provide for
				  continuation as a loss of time policy upon termination of the business
				  interest.
(3) When a policy is
				  issued pursuant to the exercise of a conversion privilege the converted policy
				  or a rider attached thereto shall reflect the relative rights of each person
				  covered under the converted policy.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.161 - Minimum standards

Current through Register Vol. 54, No. 28, July 13, 2024
The following minimum standards for benefits are prescribed
					 for the categories of coverage noted in the following
					 sections.
This section cited in 31 Pa. Code §
												88.169 (relating to specified
						disease and specified accident coverage); and 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.162 - Basic hospital expense coverage

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
				  policy which provides "Basic Hospital Expense Coverage" is defined as providing
				  coverage for a period of not less than 31 days, during any one period of
				  confinement for each person insured under the policy for the expense incurred
				  for necessary treatment and services rendered as a result of an injury or
				  sickness for at least the following:
(1) Daily
				  hospital room and board in an amount not less than the average semi-private
				  room rate in the community in which theinsured resides or $30 per
				  day.
(2) Miscellaneous hospital
				  service up to ten times the daily hospital room and board benefit for the
				  expense incurred for the charges made by the hospital for services and supplies
				  rendered by the hospital and provided for use only during the period of
				  confinement.
(3) Hospital
				  outpatient services consisting of the following:
(i) Hospital services on the day surgery is
				  performed.
(ii) Hospital services
				  rendered within 72 hours after accidental injury, in an amount not less than
				  $50.
(iii) X-ray and laboratory
				  tests to the extent that benefits for these services would have been provided
				  to an extent not less than $100 if rendered to an inpatient of the
				  hospital.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.163 - Basic medical-surgical expense coverage

Current through Register Vol. 54, No. 28, July 13, 2024
A policy which provides "Basic Medical-Surgical Expense
					 Coverage" is defined as providing coverage for each person insured under the
					 policy for the expense incurred for the necessary services rendered by a
					 physician for treatment of an injury or sickness for at least the
					 following:
(1) Surgical services on a
				  fee schedule basis with a maximum of $350 based on an acceptable relative value
				  scale of surgical procedures.
(2)
				  Anesthesia services, consisting of administration of necessary general
				  anesthesia and related procedures in connection with covered surgical service
				  rendered by a physician other than the physician or his assistant performing
				  the surgical services, to a minimum of 15% on an expense incurred basis of the
				  surgical service benefit provided.
(3) In-hospital medical services, consisting
				  of physician services rendered to a person who is a bed patient in a hospital
				  for treatment of sickness or injury other than that for which surgical care is
				  required, in an amount not less than $5.00 per call, one call per day, for at
				  least 21 such calls during "one period of confinement."
(4) Surgical schedules contained in the
				  policy shall include a provision providing coverage for procedures not
				  specifically listed in the schedules and not otherwise excluded by the policy,
				  and benefits therefore, shall be consistent with the benefits for comparable
				  procedures.
(5) Two or more
				  surgical procedures performed on the same surgical occasion and through the
				  same incisions shall be covered to the extent that payment is provided for the
				  most expensive procedure. Operations performed during the same surgical
				  session, but not through the same incision, shall be covered to the extent that
				  100% payment is provided for the most expensive operation and 50% payment for
				  the remaining total.
(6) Whenever a
				  policy is written that provides at least the coverages required for both basic
				  hospital expense coverage and basic medical-surgical expense coverages, the
				  allowable deductible may be applied to the combined coverage.
This section cited in 31 Pa. Code §
												88.169 (relating to specified
						disease and specified accident coverage); 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage); 31 Pa. Code §
												88.187 (relating to basic
						medical-surgical expense coverage form); and 31 Pa. Code §
												88.188 (relating to basic hospital
						and medical-surgical expense form).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.164 - Hospital confinement indemnity coverage

Current through Register Vol. 54, No. 28, July 13, 2024
A policy of "Hospital Confinement Indemnity Coverage"
					 provides daily benefits for hospital confinement on an indemnity basis in an
					 amount not less than $10 per day and for not less than 31 days during any one
					 period of confinement for each person insured under the
					 policy.
This section cited in 31 Pa. Code §
												88.169 (relating to specified
						disease and specified accident coverage); 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage); and 31 Pa. Code §
												88.189 (relating to hospital
						confinement indemnity coverage
						form).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.166 - Coverage for each covered person

Current through Register Vol. 54, No. 28, July 13, 2024
Major Medical Expense Coverage must provide for each
					 covered person the following:
(1)
				  Hospital room and board expenses, prior to application of the copayment
				  percentage, for not less than $50 daily or in lieu thereof the average daily
				  cost of a semi-private room rate in the area where the insured resides for a
				  period of not less than 31 days for any period of continuous hospital
				  confinement.
(2) Miscellaneous
				  hospital services, prior to application of the copayment percentage, for an
				  aggregate maximum of not less than $1,500, or 15 times the daily room and board
				  rate if specified in dollar amounts.
(3) Surgical fees, prior to application of
				  the copayment percentage, to a maximum of not less than $600 for the most
				  severe operation with the amounts provided for other operations reasonably
				  related to such maximum amount.
(4)
				  Anesthesia services, prior to application of the copayment percentage, for a
				  maximum of not less than 15% of the covered surgical fees or, alternatively, if
				  the surgical schedule is based on relative values, not less than the amount
				  provided therein for anesthesia services at the same unit value as used for the
				  surgical schedule.
(5) Doctor
				  visits, in or out of the hospital, with minimum dollar amounts per visit, prior
				  to application of the copayment percentage, equal to not less than $10 per
				  visit, covering not less than one visit per day and for an aggregate maximum of
				  such covered charges of not less than $600.
(6) Out-of-hospital diagnostic X-rays and
				  tests, prior to application of the copayment percentage, for an aggregate
				  maximum of such covered charges of not less than $600.
(7) Not fewer than three of the following
				  additional benefits prior to application of the copayment percentage, for an
				  aggregate maximum of such covered charges of not less than $1,000:
(i) In-hospital private duty registered nurse
				  services.
(ii) Diagnosis and
				  treatment by a radiologist or physiotherapist.
(iii) Rental of special medical equipment, as
				  defined by the insurer in the policy.
(iv) Artificial limbs or eyes; casts,
				  splints, trusses, or braces.
(v)
				  Treatment for functional nervous disorders, and mental and emotional
				  disorders.
(vi) Out-of-hospital
				  prescription drugs and medications.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.167 - Disability income protection coverage

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A policy of "Disability Income Protection
				  Coverage" provides for periodic payments, weekly or monthly, for a specified
				  period during the continuance of disability resulting from either sickness or
				  injury or a combination thereof. This section does not apply to those policies
				  providing business buyout coverage. Disability Income Protection Coverage must:
(1) Provide that periodic payments which are
				  payable at ages after 62 and reduced solely on the basis of age are at least
				  50% of the amounts payable prior to 62.
(2) Contain an elimination period no greater
				  than:
(i) 90 days in the case of a coverage
				  providing a benefit of 1 year or less.
(ii) 180 days in the case of coverage
				  providing a benefit of more than one year but not greater than 2
				  years.
(iii) 365 days in all other
				  cases during the continuance of disability resulting from sickness or
				  injury.
(3) Have a
				  maximum period of time for which it is payable during disability of at least 6
				  months.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.168 - Accident only coverage

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  "Accident Only Coverage" is a policy of accident insurance which provides
				  coverage, singly or in combination, for death, dismemberment, disability, or
				  hospital and medical care caused by accident.
(b) "Accident Only" policies shall provide
				  continuous 24-hour coverage. The amount of benefits payable shall not vary with
				  respect to when, where, or how the accident occurs except with respect to
				  benefits for the general classifications of "Common Carrier" and "Private
				  Passenger Automobile."
(c)
				  Accidental death and dismemberment benefits shall be payable irrespective of
				  total disability. Disability income benefits, if provided, shall not require
				  the loss to commence less than 30 days after the date of the accident, nor may
				  any policy which the insurer may cancel or refuse to renew require that it be
				  in force at the time disability commences if the accident occurred while the
				  policy was in force.
(d) The amount
				  of the accidental death benefit shall not be less than $1,000.
(e) The amount of the dismemberment benefit
				  shall not be less than:
(1) $500 in the case
				  of a single dismemberment; and
(2)
				  $1,000 in the case of a double dismemberment.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.169 - Specified disease and specified accident coverage

Current through Register Vol. 54, No. 28, July 13, 2024
(a) "Specified Disease Coverage" is a policy
				  which provides coverage for each person insured under the policy for
				  specifically named diseases with a deductible amount not in excess of $250 and
				  an overall aggregate benefit limit of not less than $5,000 and a benefit period
				  of not less than 2 years for at least the following incurred expenses:
(1) Hospital room and board for semi-private
				  accommodations and other hospital furnished medical services or
				  supplies.
(2) Treatment by a
				  legally qualified physician or surgeon.
(3) Private duty services of a registered
				  nurse (R.N.).
(4) X-ray, radium and
				  other therapy procedures used in diagnosis and treatment.
(5) Professional ambulance for local service
				  to or from a local hospital.
(6)
				  Blood transfusions, including expense incurred for blood donors.
(7) Drugs and medicines prescribed by a
				  physician.
(8) The rental of an
				  iron lung or similar mechanical apparatus. Braces, crutches and wheel chairs as
				  deemed necessary by the attending physician for the treatment of the
				  disease.
(9) Emergency
				  transportation if in the opinion of the attending physician it is necessary to
				  transport the insured to another locality for treatment of the
				  disease.
(10) Policies may contain
				  no "inside limits."
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.170 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
This section cited in 31 Pa. Code §
												88.169 (relating to specified
						disease and specified accident
						coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › MINIMUM STANDARDS FOR BENEFITS › Section 88.171 - Supplemental insurance coverage

Current through Register Vol. 54, No. 28, July 13, 2024
A policy of "Supplemental Insurance Coverage" provides
					 benefits that are less than the minimum standards for benefits required under
					 §§
										88.161-88.168. The policies or contracts
					 may be delivered or issued for delivery in this Commonwealth only if the
					 outline of coverage is completed and delivered as required by §§
										88.181-88.195 (relating to outline of
					 coverage). Supplemental policies shall clearly state that the coverage provided
					 is intended only to supplement other basic coverages. This disclosure shall be
					 part of the policy title, policy description or schedule
					 page.
This section cited in 31 Pa. Code §
												88.169 (relating to specified
						disease and specified accident coverage); and 31 Pa. Code §
												88.195 (relating to supplemental
						insurance coverage form).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.181 - Prohibition

Current through Register Vol. 54, No. 28, July 13, 2024
No policy may be delivered or issued for delivery in this
					 Commonwealth unless an appropriate outline of coverage, as prescribed by this
					 chapter, either accompanies the policy or contract or is delivered at the time
					 application is made.
The provisions of this §
												88.181 issued under The Insurance
						Company Law of 1921 (40 P. S. §§
													341-991); amended under sections 206, 506,
						1501 and 1502 of The Administrative Code of 1929 (71 P. S. §§
													66,
						186,
						411 and
						412); and sections 354 and
						616 of The Insurance Company Law of 1921 (40 P. S. §§
													477b and
						751).
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.182 - Disclosure statement

Current through Register Vol. 54, No. 28, July 13, 2024
In the event that a policy or contract is issued on a basis
					 other than that applied for, a disclosure statement properly describing the
					 policy or contract must accompany the policy or contract when it is delivered
					 and contain the following statement, in no less than 12-point type, immediately
					 above the company name: "NOTICE: Read this outline of coverage carefully. It is
					 not identical to the outline of coverage provided upon application and the
					 coverage originally applied for has not been issued."
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.183 - Changes in terminology

Current through Register Vol. 54, No. 28, July 13, 2024
Appropriate changes in terminology shall be made in
					 outlines of coverage in the case of contracts of hospital plan corporations, or
					 professional health service corporations. In any other case where the
					 prescribed outline is inappropriate for the coverage provided by the policy or
					 contract, an alternate outline shall be submitted to the Commissioner for prior
					 approval.
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.184 - Print

Current through Register Vol. 54, No. 28, July 13, 2024
The outlines of coverage required by this chapter shall be
					 plainly printed in light-faced type of a style in general use, the size of
					 which shall be uniform and not less than ten-point with a lower-case unspaced
					 alphabet length not less than 120-point.
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.185 - Text

Current through Register Vol. 54, No. 28, July 13, 2024
In the outline of coverage forms that follow, only the
					 material appearing in brackets is to be composed by the insurer in language
					 appropriate for the coverage provided. All other material shall appear in
					 exactly the form set forth in this chapter.
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.186 - Basic hospital expense coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.162 (relating to basic hospital
					 expense coverage). The items included in the outline must appear in the
					 sequence prescribed:
(COMPANY NAME)
(HOME OFFICE ADDRESS)
BASIC HOSPITAL EXPENSE COVERAGE
REQUIRED OUTLINE OF COVERAGE
(1)
Read Your Policy
				  Carefully
-This outline provides a very brief description of the
				  important features of your policy. This is not the insurance contract and only
				  the actual policy provisions will control. The policy itself sets forth in
				  detail the rights and obligations of both you and your insurance company. It
				  is, therefore, important that you READ YOUR POLICY CAREFULLY!
(2)
Basic Hospital Expense
				  Coverage
-Policies of this category are designed to provide, to persons
				  covered, coverage for hospital expenses incurred as a result of a covered
				  accident or sickness. Coverage is provided for daily hospital room and board,
				  miscellaneous hospital services, and hospital out-patient services, subject to
				  any limitations set forth in the policy. Coverage is
not
provided for physicians or surgeons fees or
unlimited
hospital
				  expenses.
(*NOTE: Immediately preceding sentence may be appropriately
					 modified, if necessary, to reflect coverage provided.)
(3) (A brief
specific
description of the benefits contained in
this policy,
in the
				  following order:
(a) Daily hospital room and
				  board;
(b) Miscellaneous hospital
				  services;
(c) Hospital out-patient
				  services; and
(d) Other benefits,
				  if any.
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts;
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage
					 provided.)
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.187 - Basic medical-surgical expense coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.163 (relating to basic
					 medical-surgical expense coverage). The items included in the outline must
					 appear in the sequence prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS)
BASIC MEDICAL-SURGICAL EXPENSE COVERAGE REQUIRED
					 OUTLINE OF COVERAGE
(1)
Read Your Policy Carefully
-This outline provides a very brief
				  description of the important features of your policy. This is not the insurance
				  contract and only the actual policy provisions will control. The policy itself
				  sets forth in detail the rights and obligations of both you and your insurance
				  company. It is, therefore, important that you READ YOUR POLICY
				  CAREFULLY!
(2)
Basic
				  Medical-Surgical Expense Coverage
-Policies of this category are
				  designed to provide, to persons insured, coverage for medical-surgical expenses
				  incurred as a result of a covered accident or sickness. Coverage is provided
				  for surgical services, anesthesia services, and in-hospital medical services,
				  subject to any limitations set forth in the policy. Coverage is
not
provided for hospital expenses or
unlimited
medical-surgical expenses. (*NOTE: Immediately
				  preceding sentence may be appropriately modified, if necessary, to reflect
				  coverage provided.)
(3) (A brief
specific
description of the benefits contained in
this
				  policy
, in the following order:
(a)
				  Surgical services;
(b) Anesthesia
				  services;
(c) In-hospital medical
				  services; and
(d) Other benefits,
				  if any.
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts,
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage
					 provided.)
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.188 - Basic hospital and medical-surgical expense form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §§
										88.162 and
					 88.163 (relating to basic hospital
					 expense coverage; and basic medical-surgical expense coverage). The items
					 included in the outline must appear in the sequence prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS)
BASIC HOSPITAL AND MEDICAL-SURGICAL EXPENSE COVERAGE
					 REQUIRED OUTLINE OF COVERAGE
(1)
Read Your Policy
				  Carefully
-This outline provides a very brief description of the
				  important features of your policy. This is not the insurance contract and only
				  the actual policy provisions will control. The policy itself sets forth in
				  detail the rights and obligations of both you and your insurance company. It
				  is, therefore, important that you READ YOUR POLICY CAREFULLY!
(2)
Basic Hospital and
				  Medical-Surgical Expense Coverage
-Policies of this category are
				  designed to provide, to persons insured, coverage for hospital and
				  medical-surgical expenses incurred as a result of a covered accident or
				  sickness. Coverage is provided for daily hospital room and board, miscellaneous
				  hospital services, hospital out-patient services, surgical services, anesthesia
				  services, and in-hospital medical services, subject to any limitations set
				  forth in the policy. Coverage is
not
provided for
unlimited
hospital or medical-surgical expenses. (*NOTE:
				  Immediately preceding sentence may be appropriately modified, if necessary to
				  reflect coverage provided.)
(3) (A
				  brief
specific
description of the benefits contained in
this policy,
in the following order:
(a) Daily hospital room and board;
(b) Miscellaneous hospital
				  services;
(c) Hospital out-patient
				  services;
(d) Surgical
				  services;
(e) Anesthesia
				  services;
(f) In-hospital medical
				  services; and
(g) Other benefits,
				  if any.
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts;
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage
					 provided.)
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.189 - Hospital confinement indemnity coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.164 of this title (relating to
					 hospital confinement indemnity coverage). The items included in the outline
					 must appear in the sequence prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS)
HOSPITAL CONFINEMENT INDEMNITY COVERAGE REQUIRED
					 OUTLINE OF COVERAGE
(1)
Read Your Policy Carefully
-This outline provides a very brief
				  description of the important features of your policy. This is not the insurance
				  contract and only the actual policy provisions will control. The policy itself
				  sets forth in detail the rights and obligations of both you and your insurance
				  company. It is, therefore, important that you READ YOUR POLICY
				  CAREFULLY!
(2)
Hospital
				  Confinement Indemnity Coverage
-Policies of this category are designed
				  to provide, to persons insured, coverage in the form of a fixed daily benefit
				  during periods of hospitalization resulting from a covered accident or
				  sickness, subject to any limitations set forth in the policy. Such policies do
not
provide any benefits other than the fixed daily indemnity
				  for hospital confinement. (*NOTE: Immediately preceding sentence may be
				  appropriately modified, if necessary, to reflect coverage provided.)
(3) (A brief
specific
description of the benefits contained in
this policy,
in the
				  following order:
(a) Daily benefit payable
				  during hospital confinement; and
(b) Duration of benefit described in
				  (a).
(c) Any other benefits
				  provided by the policy.
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts,
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage
					 provided.)
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.190 - Major medical expense coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.165 of this title (relating to
					 major medical expense coverage). The items included in the outline must appear
					 in the sequence prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS)
MAJOR MEDICAL EXPENSE COVERAGE REQUIRED OUTLINE OF
					 COVERAGE
(1)
Read Your
				  Policy Carefully
-This outline provides a very brief description of the
				  important features of your policy. This is not the insurance contract and only
				  the actual policy provision will control. The policy itself sets forth in
				  detail the rights and obligations of both you and your insurance company. It
				  is, therefore, important that you READ YOUR POLICY CAREFULLY!
(2)
Major Medical Expense
				  Coverage
-Policies of this category are designed to provide, to persons
				  insured, coverage for major hospital, medical, and surgical expenses incurred
				  as a result of a covered accident or sickness. Coverage is provided for daily
				  hospital room and board, miscellaneous hospital services, surgical services,
				  anesthesia services, in-hospital medical services, out of hospital care, and
				  prosthetic appliances, subject to any deductibles co-payment provisions, or
				  other limitations which may be set forth in the policy.
Basic
hospital or
basic
medical insurance coverage is
not
provided. (*NOTE: Immediately preceding sentence may be appropriately
				  modified, if necessary, to reflect coverage provided.)
(3) (A brief
specific
description of the benefits contained in
this policy,
in the
				  following order:
(a) Daily hospital room and
				  board;
(b) Miscellaneous hospital
				  services;
(c) Surgical
				  services;
(d) Anesthesia
				  services;
(e) In-hospital medical
				  services;
(f) Out of hospital
				  care;
(g) Prosthetic appliances;
				  and
(h) Other benefits, if any.
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts,
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage
					 provided.)
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.191 - Disability income protection coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.167 (relating to disability
					 income protection coverage). The items included in the outline must appear in
					 the sequence prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS)
DISABILITY INCOME PROTECTION COVERAGE REQUIRED
					 OUTLINE OF COVERAGE
(1)
Read Your Policy Carefully
-This outline provides a very brief
				  description of the important features of your policy. This is not the insurance
				  contract and only the actual policy provisions will control. The policy itself
				  sets forth in detail the rights and obligations of both you and your insurance
				  company. It is, therefore, important that you READ YOUR POLICY
				  CAREFULLY!
(2)
Disability
				  Income Protection Coverage
-Policies of this category are designed to
				  provide, to persons insured, coverage for disabilities resulting from a covered
				  accident or sickness, subject to any limitations set forth in the policy.
				  Coverage is
not
provided for basic hospital, basic
				  medical-surgical, or major-medical expenses. (*NOTE: Immediately preceding
				  sentence may be appropriately modified, if necessary, to reflect coverage
				  provided.)
(3) (A brief
specific
description of the benefits contained in
this
				  policy:
*NOTE: The description of benefits shall be stated clearly
					 and concisely, and shall include a description of benefit amounts, durations or
					 limits, elimination periods, inner limits, deductible or co-payment provisions
					 and any other items appropriate to the coverage provided.)
(4) (A description of the exceptions,
				  reductions and limitations contained in the policy or contract, including the
				  pre-existing conditions provisions, if any, and the circumstances under which
				  any reduction becomes operative.)
(5) (A description of the terms and
				  conditions of renewability of the policy or contract, including any limitation
				  by age, time or event, rights to change premium, status requirements and any
				  other matters appropriate to the terms and conditions of renewability
				  (including any rights of cancellation reserved to the insured).)
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.192 - Accident only coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.168 (relating to accident only
					 coverage). The items included in the outline must appear in the sequence
					 prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS)
ACCIDENT ONLY COVERAGE REQUIRED OUTLINE OF
					 COVERAGE
(1)
Read Your
				  Policy Carefully
-This outline provides a very brief description of the
				  important features of your policy. This is not the insurance contract and only
				  the actual policy provisions will control. The policy itself sets forth in
				  detail the rights and obligations of both you and your insurance company. It
				  is, therefore, important that you READ YOUR POLICY CAREFULLY!
(2)
Accident Only
				  Coverage
-Policies of this category are designed to provide, to persons
				  insured, payment for certain losses resulting from a covered accident
ONLY,
subject to any limitations contained in the policy.
				  Coverage is
not
provided for any loss due to sickness.
				  Coverage is
not
provided for basic hospital, basic
				  medical-surgical, or major-medical expenses.
(*NOTE: Immediately preceding sentence may be appropriately
					 modified, if necessary, to reflect coverage provided.)
(3) (A brief
specific
description of the benefits contained in
this policy:
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts,
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage
					 provided.)
(4) (A
				  description of the exceptions, reductions and limitations contained in the
				  policy or contract, including the pre-existing conditions provisions, if any,
				  and the circumstances under which any reduction becomes operative.)
(5) (A description of the terms and
				  conditions of renewability of the policy or contract, including any limitation
				  by age, time or event, rights to change premium, status requirements and any
				  other matters appropriate to the terms and conditions of renewability
				  (including any rights of cancellation reserved to the insured).)
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.193 - Specified disease or specified accident coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.169 (relating to specified
					 disease or specified accident coverage). The coverage shall be identified by
					 the appropriate bracketed title. The items included in the outline must appear
					 in the sequence prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS) (SPECIFIED DISEASE)
					 (SPECIFIED ACCIDENT) COVERAGE REQUIRED OUTLINE OF COVERAGE
(1)
Read Your Policy
				  Carefully
-This outline provides a very brief description of the
				  important features of your policy. This is not the insurance contract and only
				  the actual policy provisions will control. The policy itself sets forth in
				  detail the rights and obligations of both you and your insurance company. It
				  is, therefore, important that you READ YOUR POLICY CAREFULLY!
(2)
(Specified Disease) (Specified
				  Accident) Coverage
-Policies of this category are designed to provide,
				  to persons insured, restricted coverage paying benefits
ONLY
when certain losses occur as a result of (specified diseases) or (specified
				  accidents). Coverage is
not
provided for basic hospital, basic
				  medical-surgical, or major-medical expenses. (*NOTE: Immediately preceding
				  sentence may be appropriately modified, if necessary, to reflect coverage
				  provided.)
(3) (A brief
specific
description of the benefits contained in
this
				  policy:
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts,
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage
					 provided.)
(4) (A
				  description of the exceptions, reductions and limitations contained in the
				  policy or contract, including the pre-existing conditions provisions, if any,
				  and the circumstances under which any reduction becomes operative.)
(5) (A description of the terms and
				  conditions of renewability of the policy or contract, including any limitation
				  by age, time or event, rights to change premium, status requirements and any
				  other matters appropriate to the terms and conditions of renewability
				  (including any rights of cancellation reserved to the insured).)
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › OUTLINE OF COVERAGE › Section 88.195 - Supplemental insurance coverage form

Current through Register Vol. 54, No. 28, July 13, 2024
An outline of coverage, in the form prescribed in this
					 section, shall be issued in connection with policies meeting the standards of
					 §
										88.171 (relating to supplemental
					 insurance coverage). The coverage shall be identified by the appropriate
					 bracketed title. The items included must appear in the sequence
					 prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS) SUPPLEMENTAL INSURANCE
					 COVERAGE REQUIRED OUTLINE OF CONTRACT
(1)
Read Your Policy
				  Carefully
-This outline of coverage provides a very brief description
				  of the important features of your policy. This is not the insurance contract
				  and only the actual policy provisions will control. The policy itself sets
				  forth in detail the rights and obligations of both you and your insurance
				  company. It is, therefore, important that you READ YOUR POLICY
				  CAREFULLY!
(2)
(Supplemental Insurance Coverage)
-Policies of this category
				  are designed to provide, to persons insured, limited or supplemental
				  coverage.
(3) (A brief
specific
description of the benefits, including dollar amounts
				  contained in
this policy:
*NOTE: The above description of benefits shall be stated
					 clearly and concisely, and shall include a description of benefit amounts,
					 durations or limits, elimination periods, inner limits, deductible or
					 co-payment provisions and any other items appropriate to the coverage provided.
					 Proper disclosure of benefits which vary according to accidental cause shall be
					 made.)
(4) (A description of
				  any policy provisions which exclude, eliminate, restrict, reduce, limit, delay,
				  or in any other manner operate to qualify payment of the benefits described in
				  (3) above.)
(5) (A description of
				  policy provisions respecting renewability or continuation of coverage,
				  including age restrictions or any reservation of right to change
				  premiums.)
This section cited in 31 Pa. Code §
												88.171 (relating to supplemental
						insurance coverage).
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 › GENERAL PROVISIONS › Section 89.1 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
						have the following meanings, unless the context clearly indicates
						otherwise:
Act
-The Insurance Company Law of 1921
						(40
						P. S. §§
												341-991).
Advertisement
-As defined in §
											51.1 (relating to
						definitions).
Department
-The Insurance Department of
						the Commonwealth.
The provisions of this §
													89.1 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 A - REQUIREMENTS FOR ALL POLICIES AND FORMS › GENERAL PROVISIONS › Section 89.2 - Scope

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter contains the guidelines used by the
						Department in reviewing the policies, rates and related forms for individual
						and group life, accident and health insurance.
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 89.11 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
This section cited in 31 Pa. Code §
													90c.12 (relating to form number);
						  31 Pa. Code §
													90d.2 (relating to general
						  provisions); 31 Pa. Code §
													90d.9 (relating to riders); 31 Pa.
						  Code §
													90e.2 (relating to general
						  provisions); 31 Pa. Code §
													90e.11 (relating to riders); 31
						  Pa. Code §
													90f.2 (relating to general
						  provisions); 31 Pa. Code §
													90f.13 (relating to riders); 31
						  Pa. Code §
													90g.2 (relating to general
						  provisions); 31 Pa. Code §
													90g.13 (relating to riders); 31
						  Pa. Code §
													90h.2 (relating to general
						  provisions); and 31 Pa. Code § 90h.11 (relating to
						  riders).
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 89.12a - Application exceptions-statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
Notwithstanding §
											89.12(e)
						(relating to application forms), to foster diversity, equity and inclusion
						efforts, an insurer may, on an application, collect race and ethnicity data for
						diversity, equity and inclusion purposes only.
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 89.13 - Use of certain words and terms

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 use of policy captions or descriptions such as "all coverage" or "complete
					 coverage" is prohibited. The purpose of this section is to prevent
					 misunderstanding in the minds of the insured public.
(b) A policy form bearing a caption or
					 reference that this is a "Pennsylvania" policy or a "Standard" policy will not
					 be considered for approval, except if the forms are so designated by statute or
					 Departmental regulation. The purpose of this section is to prevent
					 misunderstanding in the minds of the insured public. Use of words or
					 abbreviations thereof as a part of the distinguishing form number are
					 acceptable, however, if deemed necessary or convenient to the identification of
					 the form.
(c) The word "special"
					 may not be used which might reasonably cause the insured to believe that he is
					 receiving preferential treatment.
(d) The word "compensation" may not be used
					 which might reasonably cause the policyholder to be confused with workmen's
					 compensation coverage.
This section cited in 31 Pa. Code §
													90c.8 (relating to prohibited
						  terminology); 31 Pa. Code §
													90d.6 (relating to prohibited
						  terminology); 31 Pa. Code §
													90e.8 (relating to prohibited
						  terminology); 31 Pa. Code §
													90f.9 (relating to prohibited
						  terminology); 31 Pa. Code §
													90g.9 (relating to prohibited
						  terminology); and 31 Pa. Code §
													90h.7 (relating to prohibited
						  terminology).