31 Pa. Code § 88.167 - Disability income protection coverage
(a) A policy of "Disability Income Protection
Coverage" provides for periodic payments, weekly or monthly, for a specified
period during the continuance of disability resulting from either sickness or
injury or a combination thereof. This section does not apply to those policies
providing business buyout coverage. Disability Income Protection Coverage must:
(1) Provide that periodic payments which are
payable at ages after 62 and reduced solely on the basis of age are at least
50% of the amounts payable prior to 62.
(2) Contain an elimination period no greater
than:
(i) 90 days in the case of a coverage
providing a benefit of 1 year or less.
(ii) 180 days in the case of coverage
providing a benefit of more than one year but not greater than 2
years.
(iii) 365 days in all other
cases during the continuance of disability resulting from sickness or
injury.
(3) Have a
maximum period of time for which it is payable during disability of at least 6
months.
(b) The coverage
shall not require a loss from accidental injury to commence within less than 30
days after the date of an accident, nor may any such accident policy which the
insurer may cancel or refuse to renew require that it be in force at the time
the loss commences, if the accident occurred while the policy was in
force.
(c) Benefits for specific
injury due to accident shall not be in lieu of sickness benefits, unless the
specific benefit exceeds the sickness benefit.
(d) No policy which contains a disability
income benefit or a similar type benefit may require an insured person to be
confined to his residence due to sickness or injury as a condition for any such
benefit, any change in the amount of such benefit or any change in duration of
coverage of such benefit.
(e) No
policy of accident and health insurance will be approved which contains a
provision that the disability period shall be considered to commence with the
date on which written notice is actually received by the company.
(f) Policies which limit benefits for loss of
time to specified items, such as business overhead policies, shall provide for
a premium refund in accordance with a short rate table in the event that none
of the items to be indemnified exist at the time the policy is cancelled, for
example, where a professional person discontinues his office, but only if the
insured requests cancellation of the policy and gives timely notice. Any
premium refund may be limited to one year's premium.
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