§ 89.97. Miscellaneous policy provisions.
(a) Conformity with definition of a group. A group policy of insurance approved by the Department will not be issued for delivery in this Commonwealth by an insurer to a group which does not come within the definition of a group qualified for the insurance.
(b) Variations in policies. Because of the many variations possible in group accident and health policies, the policies, their certificates and the intended insert pages reflecting possible variations will be accepted for approval, provided that the filing is accompanied by a statement showing the combination of pages whichwill be used for different types of policies.
(c) Coordination with other plans. Nonduplication or coordination of benefit provisions for group medical expense insurance coverages may provide for nonduplication or coordination with a plan or State or Federal program providing benefits or services for or by reason of medical or dental care and treatment which benefits or services are provided by group insurance or another arrangement of coverage of persons in a group whether on an insured or uninsured basis. Policies with these provisions shall stipulate clearly how the provisions will be administered.
(d) Accidental death benefit. A provision for accidental death benefit may not contain a requirement that death must occur within a specific time period.
Source The provisions of this § 89.97 amended June 23, 1978, effective June 24, 1978, 8 Pa.B. 1678. Immediately preceding text appears at serial page (13326).
Notes of Decisions Public Policy
This section and § 89.77(a)(2)(ix) evidence a public policy favoring the use of policy clauses to prevent overinsurance and avoid bonus recoveries. Weiss v. CNA, 468 F. Supp. 1291 (W.D. Pa. 1979).
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