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

Universal Citation: 31 PA Code ยง 88.162

Current through Register Vol. 54, No. 44, November 2, 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.

(b) Benefits provided under subsections (a)(1) and (a)(2) may be provided subject to a combined deductible amount not in excess of $100.

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 § 88.186 (relating to basic hospital expense coverage form); and 31 Pa. Code § 88.188 (relating to basic hospital and medical-surgical expense form).

Disclaimer: These regulations may not be the most recent version. Pennsylvania may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.