Pennsylvania Code › Title 31 - INSURANCE › Part III - Credit Insurance › Chapter 73 - CREDIT LIFE INSURANCE AND CREDIT ACCIDENT AND HEALTH INSURANCE › Section 73.107 - Accident and health insurance benefits

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
A and H benefit plans.
The prima facie premium rate standards referenced in §
									73.109 (relating to A and H
				insurance rate standards) apply to a plan of credit A and H insurance benefits,
				if the plan provides the features listed in paragraphs (1)-(7). This plan shall
				be described in a group policy and group certificate or in an individual
				policy.
(1) Single A and H coverage or joint
				A and H coverage for all eligible debtors.
(2) A monthly benefit payable upon the
				debtor's disability, subject to any maximum dollar amount of coverage specified
				in the group policy and group certificate or individual policy, equal to any of
				the following:
(i) The monthly installment
				payment required under the contract of indebtedness, for closed end
				loans.
(ii) The benefit amount
				provided in §
											73.139(f)
				(relating to credit insurance on open end loans), for open end loans.
(iii) The benefit amount provided in §
											73.140(d)
				(relating to credit insurance on closed end variable interest loans), for
				closed end variable interest loans.
(iv) The benefit amount as provided in §
											73.141(f)
				(relating to credit insurance on lease transactions), for lease
				transactions.
(3) A
				coverage period equal to the lesser of the following:
(i) The term of the indebtedness remaining at
				the time coverage is elected.
(ii)
				The term of the indebtedness remaining at the time coverage is elected to the
				time the insured debtor attains an age at which the group policy and group
				certificate or individual policy provides for coverage to terminate.
(iii) The term of the indebtedness remaining
				at the time coverage is elected until truncated coverage
				terminates.
(4) An
				elimination period as provided by the policy or certificate of either 14 days
				or 30 days following the commencement of disability, with benefits becoming
				payable on either a retroactive or nonretroactive basis.
(5) A requirement for proof of disability in
				the form of one or both of the following:
(i)
				During the first 12 months of disability, proof that the insured debtor is
				unable to perform all of the important or significant occupational duties at
				the time the disability commences. After 12 months of disability, proof that
				the debtor is unable to perform the duties required of any gainful occupation
				for which the debtor is reasonably suited by education, training or
				experience.
(ii) A medical
				determination of the insured debtor's total disability.
(6) A preexisting condition exclusion for
				disability that commences within 6 months after the effective date of coverage
				and is the result of an illness, disease or physical condition for which the
				debtor received medical advice, consultation or treatment within 6 months prior
				to the effective date of coverage. The effective date of coverage for each
				portion of the insurance attributable to a different advance under an open end
				loan is the date on which the advance occurs, or the date on which coverage is
				elected, if later.
(7) The payment
				of an A and H benefit shall cease at the scheduled expiration date of the group
				certificate or individual policy, or when the indebtedness is
				prepaid.