Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS › TERMINATION OF INSURANCE › Section 88.41 - Family policy provisions

Current through Register Vol. 54, No. 28, July 13, 2024
A family policy providing hospital, surgical, medical
					 expense, hospital confinement indemnity or accident only insurance shall
					 include provisions which shall specify the following:
(1) As to the insured, the age or event, if
				  any, upon which coverage under the policy will terminate such as age 65,
				  eligibility for Medicare.
(2) As to
				  the spouse, the age or event, if any, upon which coverage under the policy will
				  terminate such as age 65, eligibility for Medicare, legal separation, divorce,
				  or annulment.
(3) As to child, the
				  age or event upon which coverage under the policy will terminate such as age
				  19, marriage of the child, cessation of dependency. The policy shall provide
				  that coverage of an unmarried dependent child shall not terminate if that child
				  is incapable of self-sustaining employment by reason of mental retardation or
				  physical handicap, under section 617(A)(9) of the Insurance Company Law of 1921
				  (40
				  P. S. §
											752(A)(9)).
(4) For other family members, the age or
				  event, if any, or such other reasons as are appropriate for termination of
				  coverage as to persons not coming within paragraph (1), (2) or (3).
(5) A noncancellable and guaranteed renewable
				  or guaranteed renewable policy may not provide for termination of coverage of
				  the spouse solely because of the occurrence of an event specified for
				  termination of coverage of the insured, other than nonpayment of premium. The
				  provisions shall provide that in the event of the insured's death the spouse of
				  the insured, if covered under the policy, shall become the insured.
(6) The provisions shall provide that if the
				  insurer accepts the premium for coverage extending beyond the date, age, or
				  event specified for termination as to an insured family member, then coverage
				  as to such person shall continue during the period for which an identifiable
				  premium was accepted, except where such acceptance was predicated on a
				  misstatement of age.
(7) The
				  provisions shall provide that, in the event of cancellation or refusal to renew
				  by the insurer, where permitted by law, except for nonpayment of premium, of a
				  policy providing pregnancy benefits, such policy shall provide for an extension
				  of benefits as to pregnancy commencing while the policy is in force and for
				  which benefits would have been payable had the policy continued in
				  force.
(8) The provisions shall
				  provide that termination of the policy by the insurer shall be without
				  prejudice to any continuous loss which commenced while the policy was in force,
				  but the extension of benefits beyond the period the policy was in force may be
				  predicated upon the continuous disability of the insured person, limited to the
				  duration of the policy benefit period or to the payment of the maximum
				  benefits.
(9) The termination
				  provision may provide for the termination or suspension of coverage if the
				  insured individual becomes eligible for Medicare under the Social Security Act
				  (42 U.S.C.A. §
											1395 et seq ).
This section cited in 31 Pa. Code §
												88.35 (relating to accidental
						injuries).