§ 3103. Definitions in medicare supplement policies
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. Insurance
40 P.S. § 3103
§ 3103. Definitions in medicare supplement policies
As used in any medicare supplement policy issued under this act:
(1) “Accident,” “accidental injury,” “accidental means” shall be defined to employ “result” language and shall not include words which establish an accidental means test or use words such as “external, violent, visible wounds” or similar words of description or characterization. The definition shall not be more restrictive than the following: injury or injuries, for which benefits are provided, means accidental bodily injury sustained by the insured person which is the direct result of an accident, independent of disease or bodily infirmity or any other cause and occurrence while the insurance is in force. Such definition may provide that injuries shall not include injuries for which benefits are provided under any workers' compensation, employer's liability or similar law, motor vehicle no-fault plan, unless prohibited by law, or injuries occurring while the insured person is engaged in any activity pertaining to any trade, business, employment or occupation for wage or profit.
(D) any military or veterans hospital or soldiers home or any hospital contracted for or operated by any national government or agency thereof for the treatment of members or ex-members of the armed forces, except for services rendered on an emergency basis where a legal liability exists for charges made to the individual for such services.
(5) “Nurses” may be defined so that the description of nurse is restricted to a type of nurse, such as a registered graduate professional nurse, a licensed practical nurse or a licensed vocational nurse. If the words “nurse,” “trained nurse” or “registered nurse” are used without specific instruction, then the use of such terms requires the insurer to recognize the services of any individual who qualified under such terminology in accordance with the applicable statutes or administrative rules of the licensing or registry board of the Commonwealth.
(6) “Physician” may be defined by including words such as “duly qualified physician” or “duly licensed physician.” The use of such terms requires an insurer to recognize and to accept, to the extent of its obligation under the contract, all providers of medical care and treatment when such services are within the scope of the provider's licensed authority and are provided pursuant to applicable laws.
(7) “Sickness” shall not be defined to be more restrictive than the following: sickness means sickness or disease of an insured person which is diagnosed or treated after the effective date of insurance and while the insurance is in force. The definition may be further modified to exclude sickness or disease for which benefits are provided under any workers' compensation, occupational disease, employer's liability or similar law.
Credits
1982, Dec. 15, P.L. 1291, No. 292, § 3, effective July 1, 1983.
40 P.S. § 3103, PA ST 40 P.S. § 3103
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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