Subchapter A. REQUIREMENTS FOR ALL POLICIES AND FORMS
GENERAL PROVISIONS Sec.
89.1. Definitions.
89.2. Scope.
89.3. [Reserved].
89.4. [Reserved].
89.5. [Reserved].
PREPARATION OF FORMS
89.11. [Reserved].
89.12. Application forms.
89.12a. Application exceptions—statement of policy.
89.13. Use of certain words and terms.
89.14. Dismemberment, death or surgical benefits.
89.15. Simultaneous sale of insurance and equity products.
89.16. Riders and endorsements.
89.17. [Reserved].
89.18. Miscellaneous requirements.
89.21—89.23. [Reserved].
Cross References This subchapter cited in 31 Pa. Code § 89.102 (relating to guidelines for approval of forms).
GENERAL PROVISIONS
§ 89.1. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act—The Insurance Company Law of 1921 (40 P. S. § § 341—991).
Advertisement—As defined in § 51.1 (relating to definitions).
Department—The Insurance Department of the Commonwealth.
Authority The provisions of this § 89.1 amended under sections 206, 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S. § § 66, 186, 411 and 412); sections 510—514 of The Insurance Company Law (40 P. S. § § 510—514); and section 3(a) of the Accident and Health Filing Reform Act (40 P. S. § 3803(a)).
Source The provisions of this § 89.1 amended November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial page (287350).
§ 89.2. Scope.
This chapter contains the guidelines used by the Department in reviewing the policies, rates and related forms for individual and group life, accident and health insurance.
§ 89.3. [Reserved].
Source The provisions of this § 89.3 reserved November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial pages (287350) and (214541).
§ 89.4. [Reserved].
Source The provisions of this § 89.4 reserved November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial page (214541).
§ 89.5. [Reserved].
Source The provisions of this § 89.5 reserved November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial pages (214541) to (214542).
PREPARATION OF FORMS
§ 89.11. [Reserved].
Source The provisions of this § 89.11 reserved November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial pages (214542) and (287707).
Cross References This section cited in 31 Pa. Code § 90c.12 (relating to form number); 31 Pa. Code § 90d.2 (relating to general provisions); 31 Pa. Code § 90d.9 (relating to riders); 31 Pa. Code § 90e.2 (relating to general provisions); 31 Pa. Code § 90e.11 (relating to riders); 31 Pa. Code § 90f.2 (relating to general provisions); 31 Pa. Code § 90f.13 (relating to riders); 31 Pa. Code § 90g.2 (relating to general provisions); 31 Pa. Code § 90g.13 (relating to riders); 31 Pa. Code § 90h.2 (relating to general provisions); and 31 Pa. Code § 90h.11 (relating to riders).
§ 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).
§ 89.12a. Application exceptions—statement of policy.
Notwithstanding § 89.12(e) (relating to application forms), to foster diversity, equity and inclusion efforts, an insurer may, on an application, collect race and ethnicity data for diversity, equity and inclusion purposes only.
Source The provisions of this § 89.12a added April 8, 2022, effective April 9, 2022, 52 Pa.B. 2128.
§ 89.13. Use of certain words and terms.
(a) The use of policy captions or descriptions such as ‘‘all coverage’’ or ‘‘complete coverage’’ is prohibited. The purpose of this section is to prevent misunderstanding in the minds of the insured public.
(b) A policy form bearing a caption or reference that this is a ‘‘Pennsylvania’’ policy or a ‘‘Standard’’ policy will not be considered for approval, except if the forms are so designated by statute or Departmental regulation. The purpose of this section is to prevent misunderstanding in the minds of the insured public. Use of words or abbreviations thereof as a part of the distinguishing form number are acceptable, however, if deemed necessary or convenient to the identification of the form.
(c) The word ‘‘special’’ may not be used which might reasonably cause the insured to believe that he is receiving preferential treatment.
(d) The word ‘‘compensation’’ may not be used which might reasonably cause the policyholder to be confused with workmen’s compensation coverage.
Cross References This section cited in 31 Pa. Code § 90c.8 (relating to prohibited terminology); 31 Pa. Code § 90d.6 (relating to prohibited terminology); 31 Pa. Code § 90e.8 (relating to prohibited terminology); 31 Pa. Code § 90f.9 (relating to prohibited terminology); 31 Pa. Code § 90g.9 (relating to prohibited terminology); and 31 Pa. Code § 90h.7 (relating to prohibited terminology).
§ 89.14. Dismemberment, death or surgical benefits.
In contracts providing specified benefits for dismemberment, death or surgical operations, if the insurer limits its liability to one such loss as a result of a single accident, the contract shall provide that the insured is entitled to receive the largest amount applicable.
Authority The provisions of this § 89.14 amended under sections 206, 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S. § § 66, 186, 411 and 412).
Source The provisions of this § 89.14 adopted April 12, 2002, effective April 13, 2002, 32 Pa.B. 1847.
§ 89.15. Simultaneous sale of insurance and equity products.
A program which contemplates the simultaneous sale of insurance and equity products shall be submitted to the Department for review in accordance with the following guidelines:
(1) The prospective purchaser shall be given the option to purchase either the insurance product or the equity product completely independent of one another, and shall be clearly advised to this effect by the agent and in all sales material.
(2) The premium charged for the insurance product shall be a separate identifiable charge and be shown as such on sales material, bill, statement or draft used in connection with the program.
(3) Sales material or sales presentation shall separately set forth the matters pertaining to the insurance product.
(4) The premium rate for the insurance product may not be dependent upon the purchase of an equity product, fluctuate or vary with the investment experience of an equity product or vary with the amount of equity product purchased or contracted to be purchased.
(5) At any time subsequent to a simultaneous sale, the purchaser shall be given the right to divest himself of either the insurance or the equity product.
(6) A policy, contract or related form may not contain a provision which would automatically make payable insurance benefits to facilitate payment of an equity product, provided that with the consent of the insurer the beneficiary of the benefit may, by written instruction subsequent to the time he becomes eligible for the benefit, direct that all or part of the benefit be applied toward the purchase of an equity product.
(7) The term equity product as used herein may not include a variable annuity.
Source The provisions of this § 89.15 adopted September 22, 1970, effective September 23, 1970, 1 Pa.B. 336.
§ 89.16. Riders and endorsements.
(a) Endorsements, if printed on the form or to be applied by stamp, shall be separately submitted in duplicate on the letterhead of the insurer for approval or filing.
(b) ‘‘Open face’’ or ‘‘blank’’ amendment forms, riders or endorsements may be used to change variable or illustrative material without submission to the Department.
(c) A rider or endorsement which reduces or eliminates coverage under the policy shall provide for signed acceptance by the policy owner, except in the case of a rider or endorsement which is used only at the time of policy issue.
(d) With respect to impairment riders, a representative selection of the type of fill-in material shall be shown when submitting the form. Additional or alternative material which differs in fundamental approach should also be submitted at the time when the material is to be used. The material may not be used with forms delivered in this Commonwealth after receipt of nonacceptance by the Department.
Cross References This section cited in 31 Pa. Code § 90e.6 (relating to amendment of contract).
§ 89.17. [Reserved].
Source The provisions of this § 89.17 reserved November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial page (214546).
§ 89.18. Miscellaneous requirements.
(a) Riot injuries. If a policy contains an exception for injuries arising out of riots, the exception should be confined to those instances in which the insured is injured while participating in the riot.
(b) Rate books. Rate books and revisions thereof should be submitted for filing. The name of the insurer should appear on revision pages, supplements and the like, in order to facilitate proper filing in the Department. This subsection does not apply to group insurance.
Authority The provisions of this § 89.18 amended under sections 206, 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S. § § 66, 186, 411 and 412); sections 510—514 of The Insurance Company Law (40 P. S. § § 510—514); and section 3(a) of the Accident and Health Filing Reform Act (40 P. S. § 3803(a)).
Source The provisions of this § 89.18 amended November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial page (214546).
§ § 89.21—89.23. [Reserved].
Source The provisions of these § 89.21—89.23 reserved November 22, 2002, effective November 23, 2002, 32 Pa.B. 5747. Immediately preceding text appears at serial pages (214546) to (214547).
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
