Current through Pa Acts 2024-53, 2024-56 through 2024-92
Section 776.4 - Minimum standards for benefits(a) The Insurance Commissioner shall issue regulations to establish minimum standards for benefits under each of the following categories of coverage in individual policies of accident and health insurance and subscriber contracts of health plan corporations and nonprofit health service plans and certificates issued by fraternal benefit societies:(1) basic hospital expense coverage;(2) basic medical-surgical expense coverage;(3) hospital confinement indemnity coverage;(4) major medical expense coverage;(5) disability income protection coverage;(6) accident only coverage;(7) specified disease or specified accident coverage; and(8) supplemental coverage shall be permitted for all preceding categories of coverages with the exception of paragraph (7).(b) Nothing in this section shall preclude the issuance of any policy or contract which combines two or more of the categories of coverage enumerated in paragraphs (1) through (7) of subsection (a).(c) No policy or contract shall be delivered or issued for delivery in this State which does not meet the prescribed minimum standards for those categories of coverage listed in paragraphs (1) through (8) of subsection (a) which are contained within the policy or contract unless the Insurance Commissioner finds that such policy or contract will not be unjust, unfair or unfairly discriminatory to the policyholder, subscriber, any person insured under the policy, or beneficiary. Changes to a policy or contract required by regulations promulgated pursuant to this act, including changes to premium rates applicable thereto, shall be permitted by endorsement or rider unless the commissioner shall determine that such change or changes substantially alters the policy or contract.(d) Notwithstanding any other provision of this act or regulations promulgated hereunder, any policy or contract submitted for approval which does not meet the prescribed minimum standards for those categories of coverage listed in paragraphs (1) through (8) of subsection (a) which are contained within the policy or contract may be approved if, in the opinion of the Insurance Commissioner, such policy or contract is not unjust, unfair, or unfairly discriminatory to the policyholder, subscriber, any person insured under the policy or beneficiary.(e) The Insurance Commissioner shall issue regulations prescribing the method of identification of policies and contracts based upon coverages provided.1976, May 18, P.L. 123, No. 54, § 4.