§ 89.12. Application forms.
(a) When submitting a policy form to which a copy of the application will be attached when the policy is issued, a copy of the application shall be attached to the policy form. If the form of the application has already been approved, the form number and date of approval shall be shown either on the form or in the transmittal letter.
(b) If it is the practice of the insurer to attach a reduced size reproduction of the application to a form when issued, the application should be attached to each copy of the form submitted. The application should be legibly reproduced in the size to be used in the contract.
(c) An application which includes a provision for home office endorsements or corrections may not be approved for use unless it is specifically stipulated therein that a change may not be made in the amount of insurance, the age at issue, the plan of insurance or benefits applied for by the endorsements or corrections. This subsection does not apply to group applications.
(d) Applications shall contain clear and direct questions by the insurer permitting answers by the applicant only in the form of direct statements of known facts. Applications may not contain questions or representations based on indefinite or ambiguous terms or which are inconsistent with policy provisions and may not require the making of warranties by the applicant.
(e) An insurer may include questions as to demographic factors, including race and ethnicity, on an application subject to all of the following:
(1) The application clearly states that the disclosure of the data is voluntary.
(2) Questions as to the data include the following answer options verbatim:
(i) Prefer Not to Answer.
(ii) Other.
(3) At the time of application or when the data is collected, the insurer provides to the insured a written statement that contains the following information:
(i) The data will be maintained as private.
(ii) The data may not be used by the insurer for eligibility determinations, underwriting or rating purposes.
(iii) The insurer may not deny an application based on the applicant’s refusal to answer the questions related to demographic data on the application.
(4) At the time of application or when the data is collected, the insurer provides a written explanation to the insured regarding all of the following:
(i) Why the data is being requested by the insurer.
(ii) How the data will support efforts to provide equitable coverage.
(5) The insurer provides a written attestation to the Department that the insurer’s application, collection and use of data meets Federal and State law regarding unfair discrimination, including all of the following:
(i) The insured’s data is maintained as private.
(ii) The insured’s data may not be used by the insurer for eligibility determinations, underwriting or rating purposes.
(iii) The insurer may not deny an application based on the applicant’s refusal to answer the questions related to demographic data on the application.
(6) The insurer shall provide the written attestation in paragraph (5) for each product by the following dates:
(i) June 20, 2024, for products in existence as of the effective date of this regulation.
(ii) The date the product is filed.
(iii) The date that there is a material change to the application or data collection process, even if not required to be filed.
(f) Nothing in this section may be construed to require an insurer to collect demographic information, including race and ethnicity data, at the time of application or otherwise.
Authority The provisions of this § 89.12 amended under sections 206, 506, 1501, and 1502 of The Administrative Code of 1929 (71 P.S. § § 66, 186, 411 and 412); section 314 of the Accident and Health Filing Reform Act (40 P.S. § 3801.314); and the Unfair Insurance Practices Act (40 P.S. § § 1171.1—1171.15).
Source The provisions of this § 89.12 amended December 22, 2023, effective December 23, 2023, 53 Pa.B. 7932. Immediately preceding text appears at serial pages (409715) to (409716).
Cross References This section cited in 31 Pa. Code § 89.12a (relating to application exceptions—statement of policy); 31 Pa. Code § 90c.5 (relating to underwriting questions); 31 Pa. Code § 90c.6 (relating to home office endorsements/corrections provision); and 31 Pa. Code § 90c.8 (relating to prohibited terminology).
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