§ 73.107. Accident and health insurance benefits.
(a) A and H benefit plans. The prima facie premium rate standards referenced in § 73.109 (relating to A and H insurance rate standards) apply to a plan of credit A and H insurance benefits, if the plan provides the features listed in paragraphs (1)—(7). This plan shall be described in a group policy and group certificate or in an individual policy.
(1) Single A and H coverage or joint A and H coverage for all eligible debtors.
(2) A monthly benefit payable upon the debtor’s disability, subject to any maximum dollar amount of coverage specified in the group policy and group certificate or individual policy, equal to any of the following:
(i) The monthly installment payment required under the contract of indebtedness, for closed end loans.
(ii) The benefit amount provided in § 73.139(f) (relating to credit insurance on open end loans), for open end loans.
(iii) The benefit amount provided in § 73.140(d) (relating to credit insurance on closed end variable interest loans), for closed end variable interest loans.
(iv) The benefit amount as provided in § 73.141(f) (relating to credit insurance on lease transactions), for lease transactions.
(3) A coverage period equal to the lesser of the following:
(i) The term of the indebtedness remaining at the time coverage is elected.
(ii) The term of the indebtedness remaining at the time coverage is elected to the time the insured debtor attains an age at which the group policy and group certificate or individual policy provides for coverage to terminate.
(iii) The term of the indebtedness remaining at the time coverage is elected until truncated coverage terminates.
(4) An elimination period as provided by the policy or certificate of either 14 days or 30 days following the commencement of disability, with benefits becoming payable on either a retroactive or nonretroactive basis.
(5) A requirement for proof of disability in the form of one or both of the following:
(i) During the first 12 months of disability, proof that the insured debtor is unable to perform all of the important or significant occupational duties at the time the disability commences. After 12 months of disability, proof that the debtor is unable to perform the duties required of any gainful occupation for which the debtor is reasonably suited by education, training or experience.
(ii) A medical determination of the insured debtor’s total disability.
(6) A preexisting condition exclusion for disability that commences within 6 months after the effective date of coverage and is the result of an illness, disease or physical condition for which the debtor received medical advice, consultation or treatment within 6 months prior to the effective date of coverage. The effective date of coverage for each portion of the insurance attributable to a different advance under an open end loan is the date on which the advance occurs, or the date on which coverage is elected, if later.
(7) The payment of an A and H benefit shall cease at the scheduled expiration date of the group certificate or individual policy, or when the indebtedness is prepaid.
(b) Alternate benefit plans. Insurers may offer credit A and H insurance benefit plans that differ from the plan described in subsection (a). An alternate plan shall be described in a group policy and group certificate, or in an individual policy, and shall conform to the standards of section 7(b) of the act (40 P. S. § 1007.7(b)) and the applicable standards of section 618 of The Insurance Company Law of 1929 (40 P. S. § 753). The premium rate standards of § 73.109 apply to alternate benefit plans.
Cross References This section cited in 31 Pa. Code § 73.109 (relating to A and H insurance rate standards); 31 Pa. Code § 73.114 (relating to insurability requirements); 31 Pa. Code § 73.115 (relating to benefit exclusions); 31 Pa. Code § 73.116 (relating to age requirements); and 31 Pa. Code § 73.117 (relating to employment eligibility requirements).
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