§ 88.167. Disability income protection coverage.
(a) A policy of ‘‘Disability Income Protection Coverage’’ provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from either sickness or injury or a combination thereof. This section does not apply to those policies providing business buyout coverage. Disability Income Protection Coverage must:
(1) Provide that periodic payments which are payable at ages after 62 and reduced solely on the basis of age are at least 50% of the amounts payable prior to 62.
(2) Contain an elimination period no greater than:
(i) 90 days in the case of a coverage providing a benefit of 1 year or less.
(ii) 180 days in the case of coverage providing a benefit of more than one year but not greater than 2 years.
(iii) 365 days in all other cases during the continuance of disability resulting from sickness or injury.
(3) Have a maximum period of time for which it is payable during disability of at least 6 months.
(b) The coverage shall not require a loss from accidental injury to commence within less than 30 days after the date of an accident, nor may any such accident policy which the insurer may cancel or refuse to renew require that it be in force at the time the loss commences, if the accident occurred while the policy was in force.
(c) Benefits for specific injury due to accident shall not be in lieu of sickness benefits, unless the specific benefit exceeds the sickness benefit.
(d) No policy which contains a disability income benefit or a similar type benefit may require an insured person to be confined to his residence due to sickness or injury as a condition for any such benefit, any change in the amount of such benefit or any change in duration of coverage of such benefit.
(e) No policy of accident and health insurance will be approved which contains a provision that the disability period shall be considered to commence with the date on which written notice is actually received by the company.
(f) Policies which limit benefits for loss of time to specified items, such as business overhead policies, shall provide for a premium refund in accordance with a short rate table in the event that none of the items to be indemnified exist at the time the policy is cancelled, for example, where a professional person discontinues his office, but only if the insured requests cancellation of the policy and gives timely notice. Any premium refund may be limited to one year’s premium.
Cross References This section cited in 31 Pa. Code § 88.169 (relating to specified disease and specified accident coverage); 31 Pa. Code § 88.171 (relating to supplemental insurance coverage); and 31 Pa. Code § 88.191 (relating to disability income protection coverage form).
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