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

Universal Citation: 31 PA Code ยง 88.169

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

(b) "Specified disease coverage" is a policy which provides benefits for each person insured under the policy for specifically named diseases for the following:

(1) Hospital confinement in an amount of at least $100 per day for at least 500 days.

(2) Surgical expenses equal to reasonable and customary charges not to exceed an overall lifetime maximum of $3,500.

(3) Radium, cobalt, chemotherapy or X-ray therapy expenses while not hospital confined to at least $1,000. The therapy benefit shall be restored after an insured is treatment or hospitalization free for at least 12 months.

(c) A policy of "Specified Accident Coverage" provides coverage for a specifically identified kind of accident for each person insured under the policy for accidental death or accidental death and dismemberment combined, and may include coverage for disability or hospital and medical care with a benefit amount of no less than $1,000 for accidental death, $1,000 for double dismemberment and $500 for single dismemberment. Benefit amounts may not be so limited as to be unjust, unfair or misleading to the public. Benefits for disability, hospital or medical care shall be subject to the limits set forth in §§ 88.161-88.171 (relating to minimum standards for benefits).

This section cited in 31 Pa. Code § 88.193 (relating to specified disease or specified accident coverage form).

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