reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 89a.124 - Standards for benefit triggers

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
				long-term care insurance policy shall condition the payment of benefits on a
				determination of the insured's ability to perform activities of daily living
				and on cognitive impairment. Eligibility for the payment of benefits may not be
				more restrictive than requiring either a deficiency in the ability to perform
				not more than three of the activities of daily living or the presence of
				cognitive impairment.
(b) Insurers
				may use activities of daily living to trigger covered benefits in addition to
				those contained in paragraphs (1)-(6) as long as they are defined in the
				policy. Activities of daily living shall include at least the following as
				defined in §
									89a.104 (relating to policy
				definitions) and in the policy:
(1)
				Bathing.
(2) Continence.
(3) Dressing.
(4) Eating.
(5) Toileting.
(6) Transferring.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 89a.125 - Additional standards for benefit triggers for qualified long-term care insurance contracts

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For
				purposes of this section, the following definitions apply:
Chronically ill individual
-Has the meaning
				  prescribed for this term by section 7702B(c)(2) of the Internal Revenue Code of
				  1986 (26 U.S.C.A. §
											7702B(c)(2)).
(i) Under this provision, a chronically ill
				individual means an individual who has been certified by a licensed health care
				practitioner as either of the following:
(A)
				Being unable to perform (without substantial assistance from another
				individual) at least two activities of daily living for at least 90 days due to
				a loss of functional capacity.
(B)
				Requiring substantial supervision to protect the individual from threats to
				health and safety due to severe cognitive impairment.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 89a.126 - Standard format outline of coverage

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This section implements, interprets and
				makes specific section 1111 of the act (40 P. S. §
										911.1111) in prescribing a standard format
				and the content of an outline of coverage.
(b) The outline of coverage shall:
(1) Be a free-standing document, using no
				smaller than 10-point type.
(2)
				Contain no material of an advertising nature.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 89a.127 - Requirement to deliver shopper's guide

Current through Register Vol. 54, No. 28, July 13, 2024
A long-term care insurance shopper's guide in the format
				  developed by the National Association of Insurance Commissioners, or a guide
				  developed or approved by the Commissioner, shall be provided to all prospective
				  applicants of a long-term care insurance policy or certificate.
(1) In the case of producer solicitations, a
				producer shall deliver the shopper's guide prior to the presentation of an
				application or enrollment form.
(2)
				In the case of direct response solicitations, the shopper's guide shall be
				presented in conjunction with an application or enrollment form.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 89a.128 - Penalties

Current through Register Vol. 54, No. 28, July 13, 2024
In addition to other penalties provided by the laws of the
				  Commonwealth, an insurer or producer found to have violated requirements
				  relating to the regulations of long-term care insurance or the marketing of
				  long-term care insurance shall be subject to penalties under section 1114 of
				  the act (40 P. S. §
										991.1114).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 89a.129 - Permitted compensation arrangements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An insurer or other entity may provide
				commission or other compensation to a producer for the sale of a long-term care
				insurance policy or certificate only if the first year commission or other
				compensation is not greater than 50% of the first year premium.
(b) The commission or other compensation
				provided for a minimum of 5 subsequent (renewal) years may not exceed 10% of
				the renewal premium.
(c) When there
				is a replacement of an existing policy or duplication of coverage, an entity
				may not provide compensation to its producers and a producer may not receive
				compensation greater than the renewal compensation payable by the replacing or
				duplicative insurer.
(d) For
				purposes of this section, "compensation" includes pecuniary or nonpecuniary
				remuneration relating to the sale or renewal of the policy or certificate,
				including bonuses, gifts, prizes, awards and finders fees.
(e) Subsections (a) and (b) apply solely to
				producers who directly solicit applicants and insureds and who effect the sale
				of a policy or certificate and not to general agents or other entities who
				contract with or are otherwise employed by insurers.
This appendix cited in 31 Pa. Code §
											89a.110 (relating to prohibition
					 against postclaims underwriting).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Appendix A - RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE STATE OF FOR THE REPORTING YEAR 20

Current through Register Vol. 54, No. 28, July 13, 2024
Company Name:
______________________________________
Address:
______________________________________
______________________________________
Phone Number:
______________________________________
Due: March 1 annually
Instructions:
The purpose of this form is to report all rescissions of
				  long-term care insurance policies or certificates. Those rescissions
				  voluntarily effectuated by an insured are not required to be included in this
				  report. Please furnish one form per rescission.
Policy Form#
Policy
						  and Certificate #
Name of Insured
Date of Policy Issuance
Date/s
						  Claim/s Submitted
Date of Rescission
Detailed reason for rescission:
______________________________________
______________________________________
______________________________________
______________________________________
____________
Signature
____________
Name and Title (please type)
____________
Date
This appendix cited in 31 Pa. Code §
											89a.110 (relating to prohibition
					 against postclaims underwriting).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Appendix C - THINGS YOU SHOULD KNOW BEFORE YOU BUY LONG-TERM CARE INSURANCE

Current through Register Vol. 54, No. 28, July 13, 2024
THINGS YOU SHOULD KNOW BEFORE YOU BUY LONG-TERM CARE
				  INSURANCE
Long-term care Insurance
* A
						  long-term care insurance policy may pay most of the costs for your care in a
						  nursing home. Many policies also pay for care at home or other community
						  settings. Since policies can vary in coverage, you should read this policy and
						  make sure you understand what it covers before you buy it.
* [You should
not
buy this
						  insurance policy unless you can afford to pay the premiums every year.]
						  [Remember that the company can increase premiums in the future.]
* The personal worksheet includes questions
						  designed to help you and the company determine whether this policy is suitable
						  for your needs.
Medicare
* Medicare does not pay
						  for most long-term care.
Medicaid
* Medicaid will generally
						  pay for long-term care if you have very little income and few assets. You
						  probably should
not
buy this policy if you are now eligible for
						  Medicaid.
* Many people become eligible for Medicaid
						  after they have used up their own financial resources by paying for long-term
						  care services.
* When Medicaid pays your spouse's healthcare
						  service bills, you are allowed to keep your house and furniture, a living
						  allowance, and some of your joint assets.
* Your choice of long-term care services may
						  be limited if you are receiving Medicaid. To learn more about Medicaid, contact
						  your local or state Medicaid agency.
Shopper's Guide
* Make sure the
						  insurance company or producer gives you a copy of a book called the National
						  Association of Insurance Commissioners' "Shopper's Guide to Long-Term Care
						  Insurance." Read it carefully. If you have decided to apply for long-term care
						  insurance, you have the right to return the policy within 30 days and get back
						  premium you have paid if you are dissatisfied for a reason or choose not to
						  purchase the policy.
Counseling
* Free counseling and
						  additional information about long-term care insurance are available through
						  your state's insurance counseling program. Contact your state insurance
						  department or department on aging for more information about the senior health
						  insurance counseling program in your state.
This appendix cited in 31 Pa. Code §
											89a.121 (relating to
					 suitability).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Appendix D - LONG-TERM CARE INSURANCE SUITABILITY LETTER

Current through Register Vol. 54, No. 28, July 13, 2024
Dear [Applicant]:
Your recent application for long-term care insurance included
				  a "personal worksheet," which asked questions about your finances and your
				  reasons for buying long-term care insurance. For your protection, State law
				  requires us to consider this information when we review your application, to
				  avoid selling a policy to those who may not need coverage.
[Your answers indicate that long-term care insurance may not
				  meet your financial needs. We suggest that you review the information provided
				  along with your application, including the booklet "Shopper's Guide to
				  Long-Term Care Insurance" and the page titled "Things You Should Know Before
				  Buying Long-Term Care Insurance." Your state insurance department also has
				  information about long-term care insurance and may be able to refer you to a
				  counselor free of charge who can help you decide whether to buy this
				  policy.]
[You chose not to provide financial information for us to
				  review.]
We have suspended our final review of your application. If,
				  after careful consideration, you still believe this policy is what you want,
				  check the appropriate box below and return this letter to us within the next 60
				  days. We will then continue reviewing your application and issue a policy if
				  you meet our medical standards.
If we do not hear from you within the next 60 days, we will
				  close your file and not issue you a policy. You should understand that you will
				  not have coverage until we hear back from you, approve your application and
				  issue you a policy.
Please check one box and return in the enclosed
				  envelope.
[ ]
Yes
, [although my worksheet indicates that
				  long-term care insurance may not be a suitable purchase,] I wish to purchase
				  this coverage. Please resume review of my application.
[ ]
No
. I have decided not to buy a policy at
				  this time.
_________________________
APPLICANT'S SIGNATURE DATE
Please return to [issuer] at [address] by
				  [date].
This appendix cited in 31 Pa. Code §
											89a.121 (relating to
					 suitability).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Appendix E - CLAIMS DENIAL REPORTING FORM LONG-TERM CARE INSURANCE

Current through Register Vol. 54, No. 28, July 13, 2024
CLAIMS DENIAL REPORTING FORM LONG-TERM CARE
				  INSURANCE
For the State of
				  ______________________________________
For the Reporting Year of
				  ______________________________________
Company Name: ______________________________________
Due: June 30 annually
Company Address:
______________________________________
______________________________________
______________________________________
Company NAIC Number:
______________________________________
______________________________________
Contact Person:
___
Phone Number:
___
Line of Business:
___
Individual
___
Group
___
Instructions
The purpose of this form is to report all long-term care
				  claim denials under in force long-term care insurance policies. "Denied" means
				  a claim that is not paid for a reason other than for claims not paid for
				  failure to meet the waiting period or because of an applicable preexisting
				  condition.
State
Data
Nationwide
						  Data1
1
Total Number of Long-Term Care Claims
						  Reported
2
Total Number of Long-Term Care Claims
						  Denied/Not Paid
3
Number of Claims Not Paid due to Preexisting
						  Condition Exclusion
4
Number of Claims Not Paid due to Waiting
						  (Elimination) Period Not Met
5
Net Number of Long-Term Care Claims Denied
						  for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4)
6
Percentage of Long-Term Care Claims Denied
						  of Those Reported (Line 5 Divided By Line 1)
7
Number of Long-Term Care Claim Denied due
						  to:
8
* Long-Term Care Services Not Covered under
						  the Policy2
9
* Provider/Facility Not Qualified under the
						  Policy3
10
* Benefit Eligibility Criteria Not
						  Met4
11
* Other
1. The nationwide data may be viewed as a more representative
				  and credible indicator where the data for claims reported and denied for your
				  state are small in number.
2. Example-home health care claim filed under a nursing home
				  only policy.
3. Example-a facility that does not meet the minimum level of
				  care requirements or the licensing requirements as outlined in the
				  policy.
4. Examples-a benefit trigger not met, certification by a
				  licensed health care practitioner not provided, no plan of care.
This appendix cited in 31 Pa. Code §
											89a.114 (relating to reporting
					 requirements); and 31 Pa. Code §
											89a.121 (relating to
					 suitability).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89a - LONG-TERM CARE INSURANCE MODEL REGULATION › Appendix G - LONG-TERM CARE INSURANCE REPLACEMENT AND LAPSE REPORTING FORM

Current through Register Vol. 54, No. 28, July 13, 2024
For the State of
______________________________________
For the Reporting Year
						  of
______________________________________
Company Name:
						  ______________________________________
Due: June 30 annually
Company Address:
						  ______________________________________
Company NAIC Number:
						  ______________________________________
Contact Person:
						  ______________________________________
Phone Number: ( ____________ )
						  ______________________________________
Instructions
The purpose of this form is to report on a statewide
				  basis information regarding long-term care insurance policy replacements and
				  lapses. Specifically, every insurer shall maintain records for each agent on
				  that agent's amount of long-term care insurance replacement sales as a percent
				  of the agent's total annual sales and the amount of lapses of long-term care
				  insurance policies sold by the agent as a percent of the agent's total annual
				  sales. The tables below should be used to report the ten percent (10%) of the
				  insurer's agents with the greatest percentages of replacements and
				  lapses.
Listing of the 10% of Agents with the Greatest
				  Percentage of Replacements
Agent's Name
Number
						  of Policies Sold By This Agent
Number of Policies
						  Replaced By This Agent
Number of Replacements As % of
						  Number Sold By This Agent
Listing of the 10% of Agents with the Greatest
				  Percentage of Lapses
Agent's Name
Number
						  of Policies Sold By This Agent
Number of Policies
						  Lapsed By This Agent
Number of Lapses As % of Number
						  Sold By This Agent
Company Totals
Percentage of Replacement Policies Sold to Total Annual
				  Sales
___
%
Percentage of Replacement Policies Sold to Policies In Force
				  (as of the end of the preceding calendar year)
___
%
Percentage of Lapsed Policies to Total Annual Sales
___
%
Percentage of Lapsed Policies to Policies In Force (as of the
				  end of the preceding calendar year)
___
%
This appendix cited in 31 Pa. Code §
											89a.114 (relating to reporting
					 requirements).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89b - APPROVAL FOR LIFE INSURANCE, ACCIDENT AND HEALTH INSURANCE AND PROPERTY AND CASUALTY INSURANCE FILING AND FORM › GENERAL FILING PROVISIONS › Section 89b.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:
Department
-The Insurance Department of the
					 Commonwealth.
Filer
-A person or entity submitting
					 insurance or annuity forms to the Department.
Prominent type
-
(i) Font or formatting techniques which
				  differentiate selected text from other text.
(ii) The term includes, for example, capital
				  letters, contrasting color and underscoring.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89b - APPROVAL FOR LIFE INSURANCE, ACCIDENT AND HEALTH INSURANCE AND PROPERTY AND CASUALTY INSURANCE FILING AND FORM › GENERAL FILING PROVISIONS › Section 89b.2 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
				  provides the criteria for insurers to use in preparing specific form filings
				  for Department review. Additionally, the chapter provides requirements for the
				  general content of forms.
(b) In
				  addition to the requirements of this chapter, Chapter 89 (relating to approval
				  of life, accident and health insurance) also applies to these
				  filings.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89b - APPROVAL FOR LIFE INSURANCE, ACCIDENT AND HEALTH INSURANCE AND PROPERTY AND CASUALTY INSURANCE FILING AND FORM › GENERAL FILING PROVISIONS › Section 89b.3 - Form filings

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Submission of forms.
Policies, contracts, certificates,
				  endorsements, riders, applications and related forms for life insurance and
				  annuities, accident and health insurance, and property and casualty insurance,
				  intended to be issued in this Commonwealth, shall be submitted to the
				  Department in accordance with the following:
(1) Forms for life insurance and annuities
				  issued by insurance companies shall be submitted for prior approval in
				  accordance with section 354 of The Insurance Company Law of 1921 (40 P. S. §
												477b), unless specifically excepted under
				  section 354 of The Insurance Company Law of 1921. Forms for life insurance and
				  annuities issued by fraternal benefit societies shall be submitted for prior
				  approval in accordance with section 404(f) of the Fraternal Benefit Societies
				  Code (40 P. S. §
												1142-404(f)), unless
				  specifically excepted under section 354 of The Insurance Company Law of
				  1921.
(2) Forms for accident and
				  health insurance shall be filed in accordance with section 3 of the Accident
				  and Health Filing Reform Act (40 P. S. §
												3803).
(3) Forms for property and casualty insurance
				  shall be submitted for prior approval in accordance with section 354 of The
				  Insurance Company Law of 1921 unless specifically excepted under section 354 of
				  The Insurance Company Law of 1921.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89b - APPROVAL FOR LIFE INSURANCE, ACCIDENT AND HEALTH INSURANCE AND PROPERTY AND CASUALTY INSURANCE FILING AND FORM › GENERAL FILING PROVISIONS › Section 89b.4 - General filing procedure

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Number of copies.
(1) Forms
				  intended to be issued in this Commonwealth shall be submitted in duplicate for
				  hard copy filings. Filers submitting forms by means of electronic medium shall
				  submit one electronic copy. One copy of each form may be retained by the
				  Department.
(2) One copy of a form
				  intended to be issued only outside this Commonwealth shall be
				  submitted.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89b - APPROVAL FOR LIFE INSURANCE, ACCIDENT AND HEALTH INSURANCE AND PROPERTY AND CASUALTY INSURANCE FILING AND FORM › PREPARATION OF FORMS › Section 89b.11 - General contents of forms

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Name and address.
Each form shall state the full corporate or
				  legal name of the company, association, exchange or society. However, the name
				  need appear for filing purposes only on a rider, endorsement, amendment,
				  agreement or insert page. If added for filing purposes only, the name may be
				  added by any legible means. If more than one insurer is using an application, a
				  multicompany application providing for the designation of the applicable
				  insurer and available coverages, if applicable, may be used. A policy, contract
				  or fraternal certificate shall state a current address for the insurer,
				  consisting of at least a city and state or province.
(b)
Form number.
Each form
				  shall contain a form number consisting of numbers, letters, or both. The form
				  number shall be adequate to distinguish the form from all others used by the
				  insurer. The form number may be the same as that of a form to be replaced.
				  However, if the form to be replaced was approved by or filed with the
				  Department, it may not have been issued in this Commonwealth and shall be
				  withdrawn from any issuance in this Commonwealth.
(c)
Description or caption.
Each form, except an insert page, shall contain a brief description or
				  descriptive caption. This brief description or descriptive caption shall appear
				  in prominent type on the first or cover page of the form, or, in the case of a
				  policy, contract or certificate, on the specifications page if the brief
				  description or descriptive caption is visible without opening the form. The
				  brief description or descriptive caption shall contain at least the following
				  information:
(1) A designation of the general
				  type of the form, that is, policy, contract, certificate, rider, endorsement,
				  amendment, agreement, application or other general type.
(2) A designation of the specific type of
				  insurance or annuity coverage provided, or if the form does not provide
				  insurance or annuity coverage, a designation of the purpose of the
				  form.
(3) If the form is a policy,
				  contract or certificate, an indication of whether the form is participating or
				  nonparticipating with regard to paying dividends to policyholders.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90 - HOSPITAL EXPENSE BENEFITS › Section 90.1 - Definition of territories

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For
				purposes of the determination by the Commissioner of the maximum dollar amounts
				for hospital room and board daily expense benefits under section
				621.2(d)(10) of
				The Insurance Company Law of 1921 (40 P. S. §
										756.2(d)(10)), the
				Commonwealth is divided into five territories as follows:
(1) Philadelphia Area, including counties of
				Bucks, Montgomery, Chester, Delaware and Philadelphia.
(2) Allentown Area, including counties of
				Lehigh and Northampton.
(3)
				Harrisburg South Central Area, including counties of Centre, Union,
				Northumberland, Montour, Columbia, Schuylkill, Snyder, Mifflin, Juniata, Perry,
				Dauphin, Lebanon, Lancaster, York, Adams, Franklin, Fulton, Cumberland and
				Berks.
(4) Pittsburgh Area,
				including counties of Erie, Warren, McKean, Potter, Crawford, Mercer, Venango,
				Forest, Elk, Cameron, Lawrence, Butler, Clarion, Armstrong, Jefferson, Indiana,
				Clearfield, Cambria, Beaver, Allegheny, Westmoreland, Blair, Huntingdon,
				Washington, Green, Fayette, Somerset and Bedford.
(5) Wilkes-Barre Area, including counties of
				Tioga, Bradford, Susquehanna, Wayne, Clinton, Lycoming, Sullivan, Wyoming,
				Lackawanna, Pike, Luzerne, Carbon and Monroe.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › GENERAL PROVISIONS › Section 90a.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 indicates otherwise:
Act
-The Insurance Company Law of 1921
					 (40
					 P. S. §§
											341-991).
Department
-The Insurance Department of the
					 Commonwealth.
Company
-A domestic, foreign or alien life
					 insurance company licensed and authorized to transact the business of life
					 insurance in this Commonwealth.
Contract
-A group annuity contract:
(i) Which is issued in connection with one or
				  more employe benefit plans qualified under the Internal Revenue Code and
				  provides for guarantees of principal and interest on contributions allocated
				  under the contract to a separate account.
(ii) Under which benefits do not vary with
				  the investment experience of the separate account.
Separate account
-An account established
					 under the provisions of section 406.2 of the act (40 P. S. §
											506.2).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › GENERAL PROVISIONS › Section 90a.2 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
The purpose of this chapter is to provide for the
					 implementation of section 406.2 of the act (40 P. S. §
											506.2) prescribing the conditions under which
					 companies may issue contracts in this Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › GENERAL PROVISIONS › Section 90a.3 - Foreign and alien life insurance companies

Current through Register Vol. 54, No. 28, July 13, 2024
If the statutes or regulations of the place of domicile of
					 a foreign or alien insurance company prevent compliance with any specific
					 provision of this chapter, the insurance company shall so advise the Department
					 in writing.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › QUALIFICATION TO ISSUE CONTRACTS › Section 90a.11 - Licensing

Current through Register Vol. 54, No. 28, July 13, 2024
No company may deliver or issue for delivery contracts
					 within this Commonwealth unless the following requirements are met:
(1) The company is licensed and authorized to
				  transact the business of life insurance in this Commonwealth.
(2) The guarantees under the contracts are
				  not more favorable to contract holders than guarantees under comparable group
				  annuity contracts funded by the general account of the company.
(3) The investments allocated to separate
				  accounts under the contracts meet the qualitative and quantitative requirements
				  applicable to investments allocated to the general account of the
				  company.
(4) The Department is
				  satisfied that the condition or method of operation of the company in
				  connection with the issuance of such contracts will not render its operation
				  hazardous to the public or to its policyholders. In this connection, the
				  Department may consider:
(i) The history of
				  financial condition of the company, including the number of years the company
				  has been transacting the business of life insurance in this
				  Commonwealth.
(ii) The character,
				  responsibility and general fitness of the officers and directors of the
				  company.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › QUALIFICATION TO ISSUE CONTRACTS › Section 90a.12 - Years in business and capital surplus

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may prohibit the delivery or issuance of
					 contracts within this Commonwealth by a company which has not been transacting
					 the business of life insurance in this Commonwealth for a period of at least 5
					 years or which has capital and surplus, if a stock company, or an amount of
					 surplus, if a mutual company, of less than $1.5 million.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › QUALIFICATION TO ISSUE CONTRACTS › Section 90a.13 - Wholly-owned subsidiaries

Current through Register Vol. 54, No. 28, July 13, 2024
A company which is a wholly-owned subsidiary of a life
					 insurance company which has been transacting the business of life insurance in
					 this Commonwealth for a period of at least 5 years may, at the discretion of
					 the Department, be deemed to have satisfied the requirements of §
										90a.11(4)
					 (relating to licensing) if either the subsidiary or the life insurance company
					 satisfies the requirements. A wholly-owned subsidiary qualifying to issue
					 contracts by virtue of this section may continue to issue contracts only for so
					 long as it continues to remain a wholly-owned subsidiary of the parent company
					 through which it was deemed to have satisfied the applicable requirements of
					 this section, unless the subsidiary has itself satisfied the
					 requirements.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › QUALIFICATION TO ISSUE CONTRACTS › Section 90a.14 - Material to be filed

Current through Register Vol. 54, No. 28, July 13, 2024
Before a company delivers or issues for delivery contracts
					 within this Commonwealth, it shall, in addition to complying with the
					 applicable laws of the Commonwealth and the provisions of this chapter, file
					 with the Department all of the following material:
(1) A certified copy of a resolution adopted
				  by its board of directors establishing one or more separate accounts for the
				  purpose of maintaining principal and interest as guaranteed by the contracts.
				  Amendments to this resolution or a resolution superseding it shall immediately
				  be filed with the Department.
(2) A
				  copy of the latest Report of Examination of the company and Annual Statement if
				  the company has not been previously admitted.
(3) A general description of the type of
				  contracts to be issued and the employe benefit plans to be funded
				  thereby.
(4) Other information as
				  may be required by the Department.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › SEPARATE ACCOUNTS FOR INTEREST GUARANTEES › Section 90a.21 - Establishment

Current through Register Vol. 54, No. 28, July 13, 2024
A company proposing to issue contracts with the approval of
					 the Department shall establish one or more separate accounts under section
					 406.2 of the act (40 P. S. §
											506.2) under
					 which reserves for funds guaranteed as to principal amount or stated rate of
					 interest shall be maintained.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › SEPARATE ACCOUNTS FOR INTEREST GUARANTEES › Section 90a.22 - Maintenance of assets

Current through Register Vol. 54, No. 28, July 13, 2024
The company shall maintain, in any separate accounts
					 established in order to provide guarantees of principal and interest, assets
					 having a value at least equal to the accrued amounts guaranteed under the
					 contracts funded by the account. A deficit that may arise in the separate
					 account shall be adjusted by transfers to the separate account from unallocated
					 surplus or contingency reserves not required by law so that the value of the
					 assets allocated to the separate account is at least equal to the accrued
					 amounts guaranteed under the contracts.
This section cited in 31 Pa. Code §
												90a.26 (relating to reserve
						liability for contracts).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › SEPARATE ACCOUNTS FOR INTEREST GUARANTEES › Section 90a.23 - Asset valuation

Current through Register Vol. 54, No. 28, July 13, 2024
The assets allocated to a separate account established in
					 order to provide guarantees of principal and interest shall be valued in
					 accordance with rules applicable to assets allocated to the general account of
					 the company as prescribed in section 406.2(a)(4) of the act (40 P. S. §
											506.2(a)(4)).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › SEPARATE ACCOUNTS FOR INTEREST GUARANTEES › Section 90a.24 - Income, gains or losses

Current through Register Vol. 54, No. 28, July 13, 2024
Income, gains or losses realized or unrealized on a
					 separate account established to provide guarantees of principal and interest
					 shall be credited to or charged against the assets of the account without
					 regard to the other income, gains or losses of the company.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › SEPARATE ACCOUNTS FOR INTEREST GUARANTEES › Section 90a.25 - Examination

Current through Register Vol. 54, No. 28, July 13, 2024
The investments and operation of a separate account
					 established in order to provide guarantees of principal and interest shall be
					 examined periodically by the Department in accordance with the applicable laws
					 of the Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › SEPARATE ACCOUNTS FOR INTEREST GUARANTEES › Section 90a.26 - Reserve liability for contracts

Current through Register Vol. 54, No. 28, July 13, 2024
The reserve liability for contracts shall be established
					 under the requirements of section 301 of The Insurance Department Act of one
					 thousand nine hundred and twenty-one (40 P. S. §
											71). The reserve liability shall be
					 maintained in the separate account funding the contracts and shall be in
					 conformance with §
										90a.22 (relating to maintenance of
					 assets).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › SEPARATE ACCOUNTS FOR INTEREST GUARANTEES › Section 90a.27 - Annual statements

Current through Register Vol. 54, No. 28, July 13, 2024
Each life insurance company shall include, in its annual
					 statement for the business of its separate accounts, details as to all of the
					 income, disbursements, assets and liability items associated with a separate
					 account established in order to provide guarantees of principal and interest.
					 The Department may, in addition, require of a company other statements
					 concerning the business of the separate accounts as the Department may deem
					 necessary.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › FILING OF CONTRACTS, APPLICATION AND CONTRACT REQUIREMENTS › Section 90a.30 - Filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
The filing requirements applicable to contracts shall be
					 those filing requirements otherwise applicable under existing statutes and
					 regulations of the Commonwealth with respect to group annuity contract form
					 filings.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90a - SEPARATE ACCOUNTS FOR PRINCIPAL AND INTEREST GUARANTEES › FILING OF CONTRACTS, APPLICATION AND CONTRACT REQUIREMENTS › Section 90a.31 - Variable accumulations or variable benefits

Current through Register Vol. 54, No. 28, July 13, 2024
If a contract also provides for variable accumulations or
					 variable benefits, the reserves for the benefits shall be maintained in a
					 separate account other than the separate account established in order to
					 provide guarantees of principal and interest, and the contracts, to the extent
					 that they provide for the variable accumulations or variable benefits, shall
					 comply with Chapter 85 (relating to variable annuity and variable accumulation
					 annuity contracts).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.2 - General provisions

Current through Register Vol. 54, No. 28, July 13, 2024
An individual life application filing complying with the
				  following is acceptable:
(1) The
				submission letter for an application complies with applicable requirements of
				§
									89b.5 (relating to letter of
				submission).
(2) The application is
				submitted in duplicate. This complies with §
									89b.4(a)
				(relating to general filing procedure).
(3) The application is submitted in the final
				printed form intended for actual field use, unless the company requests
				tentative approval under §
									89.4(d). A form
				submitted for tentative approval is submitted in draft, printer's-proof,
				photocopied, "filer" or another legible form.
(4) The form number and the wording in the
				application are printed in easily readable type.
(5) Logos are or are not present and are more
				or less prominent than the company name.
(6) The company name is as follows:
(i) The full company name appears.
(ii) More than one licensed company name does
				or does not appear. If more than one name appears, provision is made for
				identifying the soliciting company, for example, by check-off box. Each company
				individually files for approval prior to that company's using the
				application.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.3 - Replacement questions for life insurance

Current through Register Vol. 54, No. 28, July 13, 2024
The following is acceptable:
(1) The application contains a replacement
				question. This complies with §
									81.5(b) (relating
				to duties of insurers).
(2) If the
				agent's replacement question is included in the application, the application
				does not provide for the use of one replacement question by both the applicant
				and the agent. This complies with Chapter 81 (relating to replacement of life
				insurance and annuities).
(3) A
				reinstatement, conversion, exchange or change application does or does not
				contain a replacement question.
(4)
				If the application is for both life or annuity and accident and health
				coverage, the replacement question is applicable to both coverages. This
				complies with §
									81.5(b) and
				§
									88.101 (relating to application
				form).
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.5 - Underwriting questions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Information.
(1) Information
				asked of the applicant to underwrite the coverage is in the form of a single
				direct question, not a compound question or declaratory statement, and permits
				a direct response of known fact. This complies with §
										89.12(d)
				(relating to application forms).
(2) Additional information obtained by a
				telephone interview conducted after the application has been submitted to the
				company is not used to contest coverage, unless the additional information is
				agreed to in writing by the applicant.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.6 - Home office endorsements/corrections provision

Current through Register Vol. 54, No. 28, July 13, 2024
An application does or does not contain a home office
				  endorsements/ corrections provision. If it does, the provision does or does not
				  comply with §
									89.12(c)
				  (relating to application forms). If the provision does not comply with this
				  section, the entire provision is rubberstamped or overprinted with "Not
				  Applicable in Pennsylvania" or "Not Applicable in any state where written
				  consent is required by law" or similar wording. An application for an annuity
				  does or does not comply with the §
									89.12(c) 
				  reference to "benefits applied for."
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.7 - Assignment of proxy vote

Current through Register Vol. 54, No. 28, July 13, 2024
If the application provides for assignment of a proxy vote,
				  both the life insurance or annuity and accident and health portion of a
				  combined life or annuity and accident and health application contain separate
				  places to indicate the assignment. A combined application does not contain one
				  common place to indicate the assignment for both coverages.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.8 - Prohibited terminology

Current through Register Vol. 54, No. 28, July 13, 2024
The following terminology is not present:
(1) The term "warrant" or "certify," unless
				used in reference to a tax identification or social security number, or a lost
				policy. This complies with §
									89.12(d)
				(relating to application forms).
(2) The term "special," unless used in
				reference to or to designate one or more of the following: a premium payment
				mode, a premium rating class, a settlement option or options under a policy, an
				empty box on the application within which applicant requests may be recorded.
				This complies with §
									89.13(c)
				(relating to use of certain words and terms).
(3) The term "deposit," unless used in
				conjunction with the word "premium" or the payment establishes a
				debtor-creditor relationship. This complies with §
									87.28 (relating to reference to
				payment as "deposit").
(4) The term
				"legal reserve", the absence of which complies with Chapter 139 (relating to
				prohibited phrases).
(5) The term
				"franchise," unless used in reference to accident and health
				insurance.
(6) The term "sponsor"
				unless used in reference to an entity which pays all or part of the premium or
				is a pension or welfare plan sponsor under ERISA.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.9 - Representation/agreement section

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Applications
				contain a representation/agreement section. Applications that are supplemental
				to the initial application do or do not contain such a section.
(b) A basic life insurance application
				discloses when coverage will be effective. If the first premium is paid in
				cash, or by payroll deduction authorization, automatic bank draft
				authorization, or by authorization to increase loan repayments or to charge to
				a credit card, and immediate binding or unconditional insurance coverage is not
				provided, then the disclosure as to when coverage is effective is prominent-for
				example, in bold print-unless a receipt is given.
(c) For purposes of review, a basic life
				insurance application is an application for a new policy that is not taken
				pursuant to a provision of an existing policy or group contract. Applications
				of the following types are not considered basic applications: conversion,
				exchange, requalification, change, rider or endorsement, increase in existing
				coverage and reinstatement.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.10 - Authorization to obtain medical information

Current through Register Vol. 54, No. 28, July 13, 2024
The application does or does not contain an authorization to
				  obtain medical information from sources other than the insurance company. If it
				  does, the authorization is valid for no longer than 30
				  months.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.11 - Signatures

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Basic
				application.
(1) A basic application
				for life insurance makes provision for signatures of the following, if
				applicable: proposed insured; applicant; spouse; children age 18 or over;
				payor; and owner.
(2) If children
				age 18 or over are to be insured, provision is made for their signatures since
				insurance is being applied for on their lives.
(3) If a spouse is to be insured, provision
				is made for the spouse's signature since insurance is being applied for on the
				spouse's life.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.16 - Death benefit dollar amounts

Current through Register Vol. 54, No. 28, July 13, 2024
The life insurance application does not show policy death
				  benefit dollar amounts that do not comply with §
									87.12 (relating to limited benefit
				  life policies). This complies with §
									87.12.
Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90c - INDIVIDUAL APPLICATIONS-STATEMENT OF POLICY › Section 90c.17 - Enrollment period

Current through Register Vol. 54, No. 28, July 13, 2024
If an application provides for the use of an enrollment
				  period during which coverage must be applied for, the company provides a
				  certification from a company officer that any authorized enrollment period
				  during which coverage may be applied for on the application will not be offered
				  in this Commonwealth unless there has been a lapse of at least 90 days between
				  the close of the immediately preceding enrollment period for the same product
				  and the opening of the new enrollment period. This complies with §
									51.30(c)
				  (relating to enrollment periods).