Current through Register Vol. 54, No. 49, December 7, 2024
Section 88.193 - Specified disease or specified accident coverage formAn outline of coverage, in the form prescribed in this section, shall be issued in connection with policies meeting the standards of § 88.169 (relating to specified disease or specified accident coverage). The coverage shall be identified by the appropriate bracketed title. The items included in the outline must appear in the sequence prescribed:
(COMPANY NAME) (HOME OFFICE ADDRESS) (SPECIFIED DISEASE) (SPECIFIED ACCIDENT) COVERAGE REQUIRED OUTLINE OF COVERAGE
(1)Read Your Policy Carefully-This outline provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY!(2)(Specified Disease) (Specified Accident) Coverage-Policies of this category are designed to provide, to persons insured, restricted coverage paying benefits ONLY when certain losses occur as a result of (specified diseases) or (specified accidents). Coverage is not provided for basic hospital, basic medical-surgical, or major-medical expenses. (*NOTE: Immediately preceding sentence may be appropriately modified, if necessary, to reflect coverage provided.)(3) (A brief specific description of the benefits contained in this policy:*NOTE: The above description of benefits shall be stated clearly and concisely, and shall include a description of benefit amounts, durations or limits, elimination periods, inner limits, deductible or co-payment provisions and any other items appropriate to the coverage provided.)
(4) (A description of the exceptions, reductions and limitations contained in the policy or contract, including the pre-existing conditions provisions, if any, and the circumstances under which any reduction becomes operative.)(5) (A description of the terms and conditions of renewability of the policy or contract, including any limitation by age, time or event, rights to change premium, status requirements and any other matters appropriate to the terms and conditions of renewability (including any rights of cancellation reserved to the insured).) This section cited in 31 Pa. Code § 88.171 (relating to supplemental insurance coverage).