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§ 991.1105. Disclosure and performance standards for long-term care insurance

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: January 14, 2005

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 2. Insurance Companies (Refs & Annos)
Article XI. Long-Term Care (Refs & Annos)
Effective: January 14, 2005
40 P.S. § 991.1105
§ 991.1105. Disclosure and performance standards for long-term care insurance
Currentness
(a) The department may adopt regulations, that include standards for full and fair disclosure setting forth the manner, content and required disclosures, for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions and definitions of terms.
(b) No long-term care insurance policy may:
(1) be canceled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder;
(2) contain a provision establishing a new waiting period, in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder;
(3) contain coverage for skilled nursing care only or contain coverage that provides significantly more skilled care than coverage for lower levels of care; or
(4) be marketed, offered or designed to provide coverage for less than twelve consecutive months.
(c)(1) No long-term care insurance policy or certificate may use a definition of “preexisting condition” which is more restrictive than a definition of “preexisting condition” that means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within six months preceding the effective date of coverage of an insured person.
(2) No long-term care insurance policy may exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within six months following the effective date of coverage of an insured person.

Credits

1921, May 17, P.L. 682, No. 284, art. XI, § 1105, added 1992, Dec. 15, P.L. 1129, No. 148, § 3, effective in 60 days. Amended 2004, Nov. 30, P.L. 1690, No. 216, § 9, effective Jan. 14, 2005.
40 P.S. § 991.1105, PA ST 40 P.S. § 991.1105
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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