Subchapter M. [Reserved]
Sec.
89.901—89.921. [Reserved].
Source The provisions of this Subchapter M adopted December 9, 1994, effective December 10, 1994, 24 Pa.B. 6229; reserved March 15, 2002, effective March 16, 2002, 32 Pa.B. 1475. Immediately preceding text appears at serial text pages (214654) to (214660), (284865) to (284867) and (214663) to (214675).
§ § 89.901—89.921. [Reserved].
Notes of Decisions Issue of Fact
There is a genuine issue of material fact whether insurer engaged in postclaim underwriting, where insurer permitted insured to enroll during period of open enrollment, insured purportedly provided insurer with full disclosure of his condition at time of enrollment, and insurer later denied coverage for reason of the allegedly disclosed condition. That issue of fact precludes an entry of summary judgment as to whether the insurer violated the provision prohibiting postclaim underwriting. Schneider v. UNUM Life Insurance Company of America, 149 F. Supp.2d 169 (E.D. Pa. 2001).
APPENDIX A. [Reserved]
Source The provisions of this Appendix A adopted September 15, 1989, effective September 16, 1989, 19 Pa.B. 3945; corrected September 22, 1989, effective September 16, 1989, 19 Pa.B. 4056; reserved November 30, 1990, effective December 1, 1990, 20 Pa.B. 5928. Immediately preceding text appears at serial pages (143022) to (143027).
APPENDIX B. [Reserved]
Source The provisions of this Appendix B adopted September 15, 1989, effective September 16, 1989, 19 Pa.B. 3945; corrected September 22, 1989, effective September 16, 1989, 19 Pa.B. 4056; reserved November 30, 1990, effective December 1, 1990, 20 Pa.B. 5928. Immediately preceding text appears at serial pages (143028) and (146519) to (146520).
APPENDIX C. [Reserved]
Source The provisions of this Appendix C adopted September 15, 1989, effective September 16, 1989, 19 Pa.B. 3945; reserved November 30, 1990, effective December 1, 1990, 20 Pa.B. 5928. Immediately preceding text appears at serial pages (143031) to (143033).
APPENDIX D. [Reserved]
Source The provisions of this Appendix D adopted November 30, 1990, effective December 1, 1990, 20 Pa.B. 5928; reserved July 24, 1992, effective July 25, 1992, 22 Pa.B. 3841. Immediately preceding text appears at serial pages (154999) to (155002).
APPENDIX E. [Reserved]
Source The provisions of this Appendix E adopted July 24, 1992, effective July 25, 1992, 22 Pa.B. 3841; amended May 10, 1996, effective May 11, 1996, 26 Pa.B. 2196; amended May 5, 2000, effective May 6, 2000, 30 Pa.B. 2229; amended May 6, 2005, effective May 7, 2005, 35 Pa.B. 2729. Immediately preceding text appears at serial pages (266443) to (266446) and (296145).
APPENDIX F
FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES
Company Name:
Address:
Phone Number:
Due: March 1, annually
The purpose of this form is to report the following information on each resident of this state who has inforce more than one Medicare supplement policy or certificate. The information is to be grouped by individual policyholder.
Policy and Certificate #…Date of Issuance
Signature
Name and Title (please type)
Date
Source The provisions of this Appendix F adopted July 24, 1992, effective July 25, 1992, 22 Pa.B. 3841.
APPENDIX G
ACIP Recommendations Prescribing Child
Immunization Practices
Under § 89.806(a) (relating to coverage of child immunizations), the Department of Health has established a list of citations to recommendations of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention, United States Department of Health and Human Services. The child immunization practices specified in those recommendations are subject to the insurance coverage required by the Childhood Immunization Insurance Act (act) (40 P. S. § § 3501—3508) as explained in § 89.806(a).
ACIP recommendations prescribing immunization practices are published in the Morbidity and Mortality Weekly Report (MMWR), a weekly publication of the United States Department of Health and Human Services. MMWR citations to the relevant ACIP recommendations are listed in this appendix. The effective date of insurance coverage required by the act for each ACIP recommended child immunization practice can be ascertained by consulting § 89.806(c).
If new ACIP recommendations that satisfy the standards in § 89.806(a) are published in the MMWR, they will become effective upon publication in the MMWR. The Department of Health will arrange for an update notice to appear in the Pennsylvania Bulletin within 30 days after the MMWR publication date of each future ACIP recommendation that satisfies the standards in § 89.806(a). The new recommendations will be codified in this appendix.
(1) ‘‘General Recommendations on Immunizations,’’ MMWR, January 28, 1994/Vol. 43/No. RR-1, pages 1—38.
(2) ‘‘Diphtheria, Tetanus, and Pertussis: Recommendations for Vaccine Use and Other Preventive Measures,’’ MMWR, August 8, 1991/Vol. 40/No. RR-10, pages 1—28, with the exception of materials relating to Diphtheria Antitoxin.
(3) ‘‘Pertussis Vaccination: Acellular Pertussis Vaccine for Reinforcing and Booster Use-Supplementary ACIP Statement,’’ MMWR, February 7, 1992/Vol. 41/No. RR-1, pages 1—10.
(4) ‘‘Pertussis Vaccination: Acellular Pertussis Vaccine for the Fourth and Fifth Doses of the DTP Series—Update to Supplementary ACIP Statement,’’ MMWR, October 9, 1992/Vol. 41/No. RR-15, pages 1—5.
(5) ‘‘Measles Prevention: Recommendations of the Immunization Practices Advisory Committee,’’ MMWR, December 29, 1989/Vol. 38/No. S-9, pages 1—13.
(6) ‘‘Mumps Prevention,’’ MMWR, June 9, 1989/Vol. 38/No. 22, pages 388—392, 397—400.
(7) ‘‘Rubella Prevention,’’ MMWR, November 23, 1990/Vol. 39/No. RR-15, pages 1—18.
(8) ‘‘Poliomyelitis Prevention,’’ MMWR, January 29, 1982/Vol. 31/No. 3, pages 22—26, 31—34.
(9) ‘‘Poliomyelitis Prevention: Enhanced-Potency Inactivated Poliomyelitis Vaccine—Supplementary Statement,’’ MMWR, December 11, 1987/Vol. 36/No. 48, pages 795—798.
(10) ‘‘Haemophilus b Conjugate Vaccines for Prevention of Haemophilus influenzae Type b Disease Among Infants and Children Two Months of Age and Older,’’ MMWR, January 11, 1991/Vol. 40/No. RR-1, pages 1—7.
(11) ‘‘Recommendations for Use of Haemophilus b Conjugate Vaccines and a Combined Diphtheria, Tetanus, Pertussis, and Haemophilus b Vaccine,’’ MMWR, September 17, 1993/Vol. 42/No. RR-13, pages 1—15.
(12) ‘‘Meningococcal Vaccines,’’ MMWR, May 10, 1985/Vol. 34/No. 18, pages 255—259.
(13) ‘‘Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination,’’ MMWR, November 22, 1991/Vol. 40/No. RR-13, pages 1—25.
(14) ‘‘Protection Against Viral Hepatitis,’’ MMWR, February 9, 1990/Vol. 39/No. RR-2, pages 1—21.
(15) ‘‘Update: Recommendations to Prevent Hepatitis B Virus Transmission—United States,’’ MMWR, August 9, 1995/Vol. 44/No. 30, pages 574—575.
(16) ‘‘Prevention and Control of Influenza,’’ MMWR, May 3, 1996/Vol. 45/No. RR-5, pages 1—24.
(17) ‘‘Pneumococcal Polysaccharide Vaccine,’’ MMWR, February 10, 1989/Vol. 38/No. 5, pages 64-68, 73—76.
(18) ‘‘Rabies Prevention-United States, 1991,’’ MMWR, March 22, 1991/Vol. 40/No. RR-3, pages 1—19.
(19) ‘‘Varicella-Zoster Immune Globulin for the Prevention of Chickenpox,’’ MMWR, February 24, 1984/Vol. 33/No. 7, pages 84—90, 95—100.
(20) ‘‘Prevention of Varicella,’’ MMWR, July 12, 1996/Vol. 45/No. RR-11, pages 1—25.
(21) ‘‘Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children,’’ MMWR, March 28, 1997/Vol. 46/No. RR-7.
(22) ‘‘Prevention of Pneumococcal Disease,’’ MMWR, April 4, 1997/Vol. 46/No. RR-8.
(23) ‘‘Measles, Mumps, and Rubella—Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps,’’ MMWR, May 22, 1998/Vol. 47/No. RR-8.
(24) ‘‘Human Rabies Prevention—United States, 1999,’’ MMWR, January 8, 1999/Vol 48/No. RR-1.
(25) ‘‘Prevention of Varicella Updated,’’ MMWR, May 28, 1999/Vol. 48/No. RR-6.
(26) ‘‘Prevention of Hepatitis A Through Active or Passive Immunization,’’ MMWR, October 1, 1999/Vol. 48/No. RR-12.
(27) ‘‘Poliomyelitis Prevention in the United States,’’ MMWR, May 19, 2000/Vol. 49/No. RR-5.
(28) ‘‘Prevention and Control of Meningococcal Disease and Meningococcal Disease and College Students,’’ MMWR, June 30, 2000/Vol. 49/No. RR-7.
(29) ‘‘Preventing Pneumococcal Disease Among Infants and Young Children,’’ MMWR, October 6, 2000/Vol. 49/No. RR-9.
(30) ‘‘Use of Diphtheria Toxoid-Tetanus Toxoid-Acellular Pertussis Vaccine as a Five-Dose Series,’’ MMWR, November 17, 2000/Vol. 39/No.13.
(31) ‘‘Prevention and Control of Influenza,’’ MMWR, April 20, 2001/Vol 50/No. RR-4.
(32) ‘‘Notice to Readers: FDA Approval for a Combined Hepatitis A and B Vaccine,’’ MMWR, September 21, 2001 /Vol. 50 / No.37.
(33) ‘‘Simultaneous Administration of Varicella Vaccine and Other Recommended Childhood Vaccines—United States, 1995-1999,’’ MMWR, November 30, 2001 / Vol. 50 / No.47.
(34) ‘‘General Recommendations on Immunization,’’ MMWR, February 8, 2002 / Vol. 51 / No. RR-2.
(35) ‘‘Prevention and Control of Influenza,’’ MMWR, April 12, 2002 / Vol. 51 / No.RR-3.
(36) ‘‘Notice to Readers: Resumption of Routine Schedule for Tetanus and Diphtheria Toxoids,’’ June 21, 2002/Vol. 51/No. 24.
(37) ‘‘Notice to Readers: Food and Drug Administration Approval of a Fifth Acellular Pertussis Vaccine for Use Among Infants and Young Children—United States, 2002,’’ July 5, 2002/Vol. 51/No. 26.
(38) ‘‘Notice to Readers: Resumption of Routine Schedule for Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine and for Measles, Mumps, and Rubella Vaccine,’’ July 12, 2002/Vol. 51/No. 27.
(39) ‘‘Hepatitis B Vaccination Among High-Risk Adolescents and Adults—San Diego, California, 1998—2001,’’ July 19, 2002/Vol. 51/No. 28.
(40) ‘‘National, State, and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months—United States, 2001,’’ August 2, 2002/Vol. 51/No. 30.
(41) ‘‘Impact of Vaccine Shortage on Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Coverage Rates Among Children Aged 24 Months—Puerto Rico, 2002,’’ August 2, 2002/Vol. 51/No 30.
(42) ‘‘Yellow Fever Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002,’’ November 8, 2002/Vol. 51/No. RR—17.
(43) ‘‘Notice to Readers: Use of Anthrax Vaccine in Response to Terrorism: Supplemental Recommendations of the Advisory Committee on Immunization Practices,’’ November 15, 2002/Vol. 51/No. 45.
(44) ‘‘Update: Influenza Activity—United States, 2002—03 Season,’’ January 17, 2003/Vol. 52/No. 2.
(45) ‘‘Surveillance for Safety After Immunization: Vaccine Adverse Event Reporting System (VAERS)—United States, 1991—2001,’’ January 24, 2003/Vol. 52/No. SS—1.
(46) ‘‘Pneumococcal Vaccination for Cochlear Implant Candidates and Recipients: Updated Recommendations of the Advisory Committee on Immunization Practices,’’ August 8, 2003/Vol. 52/No. 31.
(47) ‘‘Notice to Readers: Supplemental Recommendations About the Timing of Influenza Vaccination, 2003-04 Season,’’ August 22, 2003/Vol. 52/No. 33.
(48) ‘‘Notice to Readers: FDA Approval of Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed, (INFANRIX®) for Fifth Consecutive DTaP Vaccine Dose,’’ September 26, 2003/Vol. 52/No. 38.
(49) ‘‘Notice to Readers: Revised Standards for Adult Immunization Practices and Child and Adolescent Immunization Practices, 2003,’’ October 10, 2003/Vol. 52/No. 40.
(50) ‘‘Notice to Readers: Limited Supply of Pneumococcal Conjugate Vaccine,’’ December 19, 2003/Vol. 52/No. 50.
(51) ‘‘Recommended Childhood and Adolescent Immunization Schedule—United States, January—June 2004,’’ January 16, 2004/Vol. 52/No. 1.
(52) ‘‘Tiered Use of Inactivated Influenza Vaccine in the Event of a Vaccine Shortage,’’ August 5, 2005/Vol. 54/No. 30.
(53) ‘‘National, State, and Urban Area Vaccination Coverage Among Children Aged 19-35 Months—United States, 2004,’’ July 29, 2005/Vol. 54/No. 29.
(54) ‘‘Notice to Readers: Satellite Broadcast on Immunization Update 2005,’’ July 1, 2005/Vol. 54/No. 25.
(55) ‘‘Prevention and Control of Meningococcal Disease: Recommendations of the ACIP,’’ July 30, 2005/Vol. 54/No. 21.
(56) ‘‘Notice to Readers: National Infant Immunization Week—April 24 through 30, 2005,’’ April 15, 2005/Vol. 54/No. 14.
(57) ‘‘Update: Influenza Activity—United States, 2004-05 Season Notice to Readers,’’ April 8, 2005/Vol. 54/No. 13.
(58) ‘‘Estimated Influenza Vaccination Coverage Among Adults and Children—United States, September 1, 2004, through January 31, 2005,’’ April 1, 2005/Vol. 54/No. 12.
(59) ‘‘Hepatitis A Vaccination Coverage Among Children Aged 24-35 Months—United States, 2003’’ February 18, 2005/Vol. 54/No. 6.
(60) ‘‘Notice to Readers: Improved Supply of Meningococcal Conjugate Vaccine, Recommendation to Resume Vaccination of Children Aged 11—12 Years,’’ November 3, 2006/Vol. 55/No. 43.
(61) ‘‘Update: Guillain Barré Syndrome Among Recipients of Menactra® Meningococcal Conjugate Vaccine—United States, June 2005—September 2006,’’ October 20, 2006/Vol. 55/No. 41.
(62) ‘‘Pertussis Outbreak in an Amish Community—Kent County, Delaware, September 2004—February 2005,’’ August 4, 2006/Vol. 55/No. 30.
(63) ‘‘Varicella Outbreak Among Vaccinated Children—Nebraska, 2004,’’ August 4, 2006/Vol. 55/No. 30.
(64) ‘‘Notice to Readers: Expansion of Use of Live Attenuated Influenza Vaccine (FluMist®) to Children Aged 2—4 Years and Other FluMist Changes for the 2007-2008 Influenza Season,’’ November 23, 2007/Vol. 56/No. 46.
(65) ‘‘Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP),’’ October 19, 2007/Vol. 56/No. 41.
(66) ‘‘Notice to Readers: FDA Approval of an Alternate Dosing Schedule for a Combined Hepatitis A and B Vaccine (Twinrix®),’’ October 12, 2007/Vol. 56/No. 40.
(67) ‘‘Influenza Vaccination Coverage Among Children Aged 6—23 Months—United States, 2005-2006 Influenza Season,’’ September 21, 2007/Vol. 56/No. 37.
(68) ‘‘Influenza Vaccination Coverage Among Children Aged 6—59 Months—Six Immunization Information System Sentinel Sites, 2006-2007 Influenza Season’’
(69) ‘‘National, State, and Local Area Vaccination Coverage Among Children Aged 19—35 Months—United States, 2006,’’ August 31, 2007/Vol. 56/No. 34.
(70) ‘‘National Vaccination Coverage Among Adolescents Aged 13—17 Years—United States, 2006.’’
(71) ‘‘Notice to Readers: Revised Recommendations of the Advisory Committee on Immunization Practices to Vaccinate All Persons Aged 11—18 Years with Meningococcal Conjugate Vaccine,’’ August 10, 2007/Vol. 56/No. 31.
(72) ‘‘Hepatitis A Vaccination Coverage Among Children Aged 24—35 Months—United States, 2004-2005,’’ July 13, 2007/Vol. 56/No. 27.
(73) ‘‘Newborn Hepatitus B Vaccination Coverage Among Children Born January 2003—June 2005—United States’’ August 1, 2008/Vol. 57/No. 30.
(74) ‘‘Prevention and Control of Influenza’’ August 8, 2008/Vol. 57/No. RR07.
(75) ‘‘Update: Measles—United States, January—July 2008’’ August 22, 2008/Vol. 57/No. 33.
(76) ‘‘National, State and Local Area Vaccination Coverge Among Children Aged 19—35 Months’’ September 5, 2008/Vol. 57/No. 35.
(77) ‘‘Influenza Vaccination Coverage Among Children Aged 6—59 Months—Eight Immunization Information System Sentinel Sites, United States, 2007-08 Influenza Season’’ September 26, 2008/Vol. 57/No. 38.
(78) ‘‘State-Specific Influenza Vaccination Coverage Among Adults United States, 2006-07 Influenza Season’’ September 26, 2008/Vol. 57/No. 38.
(79) ‘‘Licensure of a Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Inactivated Poliovirus, and Haemophilus b Conjugate Vaccine and Guidance for Use in Infants and Children’’ October 3, 2008/Vol. 57/No. 39.
(80) ‘‘Licensure of a Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine and Guidance for Use as a Booster Dose’’ October 3, 2008/Vol. 57/No. 39.
(81) ‘‘Updated Recommendations for Isolation of Persons with Mumps’’ October 10, 2008, Vol. 57/No. 40.
(82) ‘‘Vaccination Coverage Among Adolescents Aged 13—17 Years—United States, 2007’’ October 10, 2008/Vol. 57/No. 40.
(83) ‘‘Rotavirus Surveillance—Worldwide, 2001—2008’’ November 21, 2008/Vol. 57/No. 46.
(84) ‘‘Continued Shortage of Haemophilus influenzae Type b (Hib) Conjugate Vaccines and Potential Implications for Hib Surveillance—Unites States, 2008’’/Vol. 57/No. 46.
(85) ‘‘Implementation of Newborn Hepatitis B Vaccination—Worldwide, 2006’’/November 21, 2008/Vol. 57/No. 46.
(86) ‘‘Progress in Global Measles Control and Mortality Reduction, 2000—2007’’/December 5, 2008/Vol. 57/No. 48.
(87) ‘‘Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza a (H1N1) Virus—United States, 2009’’/August 7, 2009/Vol. 58/No. 30.
(88) ‘‘Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) Regarding Routine Poliovirus Vaccination’’/August 7, 2009/Vol. 58/No. 30.
(89) ‘‘National, State, and Local Area Vaccination Coverage Among Children Aged 19—35 Months—United States, 2008’’/August 28, 2009/Vol. 58/No. 33.
(90) ‘‘Surveillance for Pediatric Deaths Associated with 2009 Pandemic Influenza A (H1N1) Virus Infection—United States, April—August 2009’’/September 4, 2009/Vol. 58/No. 34.
(91) ‘‘Oseltamivir-Resistant 2009 Pandemic Influenza A (H1N1) Virus Infection in Two Summer Campers Receiving Prophylaxis—North Carolina, 2009’’/September 11, 2009/Vol. 58/No. 35.
(92) ‘‘National, State, and Local Area Vaccination Coverage Among Adolescents Aged 13—17 Years—United States, 2008’’/September 18, 2009/Vol. 58/No. 36.
(93) ‘‘Updated Recommendations from the Advisory Committee on Immunization Practices (ACIP) for Use of Hepatitis A Vaccine in Close Contacts of Newly Arriving International Adoptees’’/September 18, 2009/Vol. 58/No. 36.
(94) ‘‘Licensure of a Haemophilus influenzae Type b (Hib) Vaccine (Hiberix) and Updated Recommendations for Use of Hib Vaccine’’/September 18, 2009/Vol. 58/No. 36.
(95) ‘‘Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Revaccination of Persons at Prolonged Increased Risk for Meningococcal Disease’’/September 25, 2009/Vol. 58/No. 37.
(96) ‘‘Influenza Vaccination Coverage Among Children Aged 6—23 Months—United States, 2007—08 Influenza Season’’/October 2, 2009/Vol. 58/No. 38.
(97) ‘‘Influenza Vaccination Coverage Among Children and Adults—United States, 2008—09 Influenza Season’’/October 9, 2009/Vol. 58/No. 39.
(98) ‘‘Norovirus Outbreaks on Three College Campuses—California, Michigan and Wisconsin, 2008’’/October 9, 2009/Vol. 58/No. 39.
(99) ‘‘Reduction in Rotavirus After Vaccine Introduction—United States, 2000—2009’’/October 23, 2009/Vol. 58/No. 41.
(100) ‘‘Effectiveness of 2008—09 Trivalent Influenza Vaccine Against 2009 Pandemic Influenza A (H1N1)—United States, May—June 2009’’/November 13, 2009/Vol. 58/No. 44.
(101) ‘‘Mumps Outbreak—New York, New Jersey, Quebec, 2009’’/November 20, 2009/Vol. 58/No. 45.
(102) ‘‘Safety of Influenza A (H1N1) 2009 Monovalent Vaccines—United States, October 1—November 24, 2009’’/December 11, 2009’’/Vol. 58/No. 48.
(103) ‘‘Recommended Adult Immunization Schedule—United States, 2010’’/January 15, 2010/Vol. 59(01)/1-4.
(104) ‘‘Update: Influenza Activity—United States, August 30, 2009-January 9, 2010’’/January 22, 2010/Vol. 59(02)/38-43.
(105) ‘‘Update: Mumps Outbreak—New York and New Jersey, June 2009-January 2010’’/February 12, 2010/Vol. 59(05)/125-129.
(106) ‘‘Progress in Immunization Information Systems—United States, 2008’’/February 12, 2010/Vol. 59(05)/133-135.
(107) ‘‘Licensure of a 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Recommendations for Use Among Children-Advisory Committee on Immunization Practices (ACIP), 2010’’/March 12, 2010/Vol. 59(09)/258-261.
(108) ‘‘Prevnar 13 Licensure’’/March 12, 2010/Vol. 59(09)/258-261.
(109) ‘‘Licensure of a Meningococcal Conjugate Vaccine (Menveo) and Guidance for Use Advisory Committee on Immunization Practices (ACIP), 2010’’/March 12, 2010/Vol. 59(09)/273.
(110) ‘‘2009 Pandemic Influenza A (H1N1) in Pregnant Women Requiring Intensive Care—New York City, 2009’’/March 26, 2010/Vol 59(11)/321-326.
(111) ‘‘Interim Results: State-Specific Influenza A (H1N1) 2009 Monovalent Vaccination Coverage—United States, October 2009 to January 2010’’/April 2, 2010/Vol. 59(12)/363-368.
(112) ‘‘Interim Results: State-Specific Seasonal Influenza Vaccination Coverage—United States, August 2009 to January 2010’’/April 30, 2010/Vol. 59(16)/477-484.
(113) ‘‘FDA Licensure of Bivalent Human Papillomavirus Vaccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the Advisory Committee on Immunization Practices (ACIP)’’/May 28, 2010/Vol. 59(20)/626-629.
(114) ‘‘FDA Licensure of Quadrivalent Human Papillomavirus Vaccine (HPV4, Gardasil) for Use in Males and Guidance from the Advisory Committee on Immunization Practices (ACIP)’’/May 28, 2010/Vol. 59(20)/630-632.
(115) ‘‘Preliminary Results: Surveillance for Guillain-Barré Syndrome After Receipt of Influenza A (H1N1) 2009 Monovalent Vaccine—United States, 2009-2010’’/June 4, 2010/Vol. 59(21)/657-661.
(116) ‘‘Addition of Severe Combined Immunodeficiency as a Contraindication for Administration of Rotavirus Vaccine’’/June 11, 2010/Vol. 59(22)/687-688.
(117) ‘‘Hepatitis A Vaccination Coverage Among U.S. Children Aged 12-23 Months—Immunization Information System Sentinel Sites, 2006-2009’’/July 2, 2010/Vol. 59/No. 25.
(118) ‘‘Seasonal Influenza Vaccination Coverage Among Children Aged 6 Months-18 Years—Eight Immunization Information System Sentinel Sites, United States, 2009-10 Influenza Season’’/October 8, 2010/Vol. 59/No. 39.
(119) ‘‘Prevention of Pneumococcal Disease Among Infants and Children—Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine’’/December 10, 2010/Vol. 59/No. RR11.
(120) ‘‘Updated Recommendations for Use of Meningococcal Conjugate Vaccines-Advisory Committee on Immunization Practices (ACIP), 2010’’/January 28, 2011/Vol. 60/No. 3.
(121) ‘‘Recommended Immunization Schedules for Persons Aged 0 Through 18 Years—United States, 2011’’/February 11, 2011/Vol. 60/No. 5.
(122) ‘‘Measles Imported by Returning U.S. Travelers Aged 6-23 Months, 2001-2011’’/April 8, 2011/Vol. 60/No. 1.
(123) ‘‘Measles-United States, January-May 20, 2011’’/May 27, 2011/Vol. 60/No. 20.
(124) ‘‘Licensure of a Meningococcal Conjugate Vaccine for Children Aged 2 Through 10 Years and Updated Booster Dose guidance for Adolescents and Other Persons at Increased Risk for Meningococcal Disease—Advisory Committee on Immunization Practices (ACIP), 2011’’/August 5, 2011/Vol. 60/No. 30.
(125) ‘‘National and State Vaccination Coverage Among Adolescents Aged 13 Through 17 Years—United States, 2010’’/August 26, 2011/Vol. 60/No. 33.
(126) ‘‘National and State Vaccination Coverage Among Children Aged 19-35 Months—United States, 2010’’/September 2, 2011/Vol. 60/No. 34.
(127) ‘‘Recommendation of the Advisory Committee on Immunization Practices (ACIP) for Use of Quadrivalent Meningococcal Conjugate Vaccine (MenACWY-D) Among Children Aged 9 Through 23 Months at Increased Risk for Invasive Meningococcal Disease’’/October 14, 2011/Vol. 60/No. 40.
(128) ‘‘Invasive Pneumococcal Disease and 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Coverage Among Children Aged ‹=59 Months—Selected United States Regions, 2010-2011’’/November 4, 2011/Vol. 60/No. 43.
(129) ‘‘Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2012-13 Influenza Season’’/August 17, 2012/Vol. 61/No. 32.
(130) ‘‘National and State Vaccination Coverage Among Adolescents Aged 13-17 Years—United States, 2011’’/August 31, 2012/Vol. 61/No. 34.
(131) ‘‘Vaccination Coverage Among Children in Kindergarten—United States, 2011-12 School Year’’/August 24, 2012/Vol. 61/No. 33.
(132) ‘‘National, State, and Local Area Vaccination Coverage Among Children Aged 19-35 Months—United States, 2011’’/September 7, 2012/Vol. 61/No. 35.
(133) ‘‘Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP)’’/March 22, 2013/Vol. 62/No. RR02.
(134) ‘‘Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children Aged 6—18 Years with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP)’’/June 28, 2013/Vol. 62/No. 25.
Source The provisions of this Appendix G adopted February 3, 1995, effective February 4, 1995, 25 Pa.B. 511; amended August 16, 1996, effective August 17, 1996, 26 Pa.B. 3958; amended August 10, 2001, effective August 11, 2001, 31 Pa.B. 4498; amended October 25, 2002, effective October 26, 2002, 32 Pa.B. 5352; amended March 14, 2003, effective March 15, 2003, 33 Pa.B. 1418; amended April 16, 2004, effective April 17, 2004, 34 Pa.B. 2135; amended September 17, 2004, effective September 18, 2004, 34 Pa.B. 5218; amended September 16, 2005, effective September 17, 2005, 35 Pa.B. 5190; amended January 19, 2007, effective January 20, 2007, 37 Pa.B. 372; amended December 21, 2007, effective December 22, 2007, 37 Pa.B. 6851; amended February 27, 2009, effective February 28, 2009, 39 Pa.B. 1167; amended February 5, 2010, effective February 6, 2010, 40 Pa.B. 760; amended September 17, 2010, effective September 18, 2010, 40 Pa.B. 5404; amended March 4, 2011, effective March 5, 2011, 41 Pa.B. 1263; amended October 28, 2011, effective October 29, 2011, 41 Pa.B. 5821; amended April 6, 2012, effective April 7, 2012, 42 Pa.B. 1929; amended February 1, 2013, effective February 2, 2013, 43 Pa.B. 745; amended October 11, 2013, effective October 12, 2013, 43 Pa.B. 6079. Immediately preceding text appears at serial pages (311232), (296147) to (296148), (342055) to (342056), (356173) to (356174) and (365547).
Cross References This appendix cited in 31 Pa. Code § 89.806 (relating to coverage of child immunizations).
APPENDIX H
Immunizing Agents and Doses
Under § 89.807(b) (relating to immunizing agents, doses and AWPs), the Department of Health has established a table setting forth immunizing agent and dose information extracted from recommendations of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention, United States Department of Health and Human Services. The relevant ACIP recommendations are those which prescribe child immunization practices and are currently in effect. The child immunization practices specified in those recommendations are subject to the insurance coverage required by the Childhood Immunization Insurance Act (act) (40 P. S. § § 3501—3508) as explained in § 89.806(a) (relating to coverage of child immunizations).
Under § 89.807(b), the Department of Health is to also periodically publish a notice in the Pennsylvania Bulletin setting forth the AWPs for dosage units of immunizing agents which the relevant ACIP recommendations prescribe for use in child immunizations. The AWPs are calculated as described in § 89.807(a) and should be recalculated monthly as explained in that subsection.
The immunizing agent and dose information is set forth in this appendix. This information is subject to change. It may be superseded, as explained in § § 89.806(a) and 89.807(a).
The Department of Health will arrange for an update notice to appear in the Pennsylvania Bulletin within 30 days after a new ACIP recommendation which satisfies the standards in § 89.806(a) is published in the Morbidity and Mortality Weekly Report, a weekly publication of the United States Department of Health and Human Services. The new recommendations will be codified in this appendix.
2011 List of Immunizing Agents and Average Wholesale Prices
Product Name, Company Brand/Product Name NDC Number Unit Dose AWP/Dose* Diphtheria Tetanus acellular Pertussis Vaccine (DTaP): sanofi Pasteur Tripedia 49281-0298-10 10 x 1 0.5 ml $27.97 sanofi pasteur Daptacel 49281-0286-10 10 x 1 0.5 ml $28.83 GlaxoSmithKline Infanrix—syringe 58160-0812-46 10 x 1 0.5 ml $23.02 GlaxoSmithKline Infanrix 58160-0810-11 10 x 1 0.5 ml $24.70 Tetanus Diphtheria acellular Pertussis Vaccine (TdaP): sanofi pasteur Adacel 49281-0400-10 10 x 1 0.5 ml $46.15 sanofi pasteur Adacel 49281-0400-15 5 x 1 0.5 ml $46.15 GlaxoSmithKline Boostrix 58160-0842-11 10 x 1 0.5 ml $44.61 GlaxoSmithKline Boostrix—syringe 58160-0842-51 10 x 1 0.5 ml $44.61 Diphtheria Tetanus pediatric Vaccine (DT pediatric): sanofi pasteur DT Pediatric 49281-0278-10 10 x 1 0.5 ml $37.27 Diphtheria Tetanus acellular Pertussis/Haemophilus Influenzae B (DTaP-HIB): sanofi pasteur TriHIBit 49281-0597-05 5 x 1 0.5 ml $56.58 Tetanus Diphtheria adult Vaccine (Td adult): sanofi pasteur Decavac 49281-0291-83 10 x 1 0.5 ml $24.17 sanofi pasteur Decavac 49281-0291-10 10 x 1 0.5 ml $24.17 Merck & Co. Td Vaccine 14362-0111-03 10 x 1 0.5 ml $22.34 Diphtheria, Tetanus, acellular Pertussis, Haemophilus Influenzae B, Polio (DTaP, HIB, IPV): sanofi pasteur Pentacel 49281-0510-05 5 x 1 0.5 ml $92.22 Diphtheria, Tetanus, acellular Pertussis, Polio (DTap, IPV): GlaxoSmithKline Kinrix—syringe 58160-0812-51 10 x 1 0.5 ml $57.00 GlaxoSmithKline Kinrix 58160-0812-11 10 x 1 0.5 ml $57.00 Diphtheria, Tetanus, acellular Pertussis, Hepatitis B, Polio (DTaP, Hep B, IPV): GlaxoSmithKline Pediarix 58160-0811-11 10 x 1 0.5 ml $84.12 GlaxoSmithKline Pediarix—syringe 58160-0811-46 5 x 1 0.5 ml $84.12 Tetanus Toxoid: sanofi pasteur Tetanus toxoid 49281-0820-10 10 x 1 0.5 ml $37.03 Haemophilus Influenzae Type B Vaccine (HIB): sanofi pasteur ActHIB 49281-0545-05 5 x 1 10 mcg $29.00 Merck & Co. Pedvax HIB 00006-4897-00 10 x 1 7.5 mcg $27.32 GlaxoSmithKline Hiberix 58160-0806-05 10 x 1 0.5 ml $8.66 Injectable Polio Vaccine Inactivated (Salk Enhanced IPV): sanofi pasteur IPOL 49281-0860-55 10 x 1 0.5 ml $30.36 sanofi pasteur IPOL 49281-0860-10 5.0 ml 0.5 ml $30.36 Measles Mumps Rubella Vaccine (MMR): Merck & Co. MMR II 00006-4681-00 10 x 0.5 0.5 ml $55.40 Measles Vaccine (Rubeola): Merck & Co. Attenuvax 0006-4589-00 10 x 0.5 0.5 ml $20.48 Meningococcal Conjugate Vaccine (MCV4): sanofi pasteur Menactra 49281-0589-05 5 x 1 0.5 ml $127.64 sanofi pasteur Menactra 49281-0589-15 5 x 1 0.5 ml $127.64 Novartis Menveo 46028-0208-01 5 x 1 0.5 ml $106.49 Meningococcal Polysaccharide Vaccine: sanofi pasteur Menomune-
A/C/Y/W-13549281-0489-91 10 x 1 0.5 ml $130.11 sanofi pasteur Menomune-
A/C/Y/W-13549281-0489-01 each 0.5 ml $130.11 Mumps Vaccine: Merck & Co. Mumpsvax 00006-4584-00 10 x 0.5 0.5 ml $26.54 Rubella Vaccine: Merck & Co. Meruvax II 00006-4673-00 10 x 0.5 0.5 ml $22.83 Hepatitis A Vaccine (HEP-A): Merck & Co. VAQTA—syringe 00006-4096-31 1.0 ml 1.0 ml $77.89 Merck & Co. VAQTA—syringe 00006-4096-06 6 x 1 1.0 ml $77.87 Merck & Co. VAQTA 00006-4841-00 1.0 ml 1.0 ml $76.21 Merck & Co. VAQTA 00006-4841-41 10 x 1 1.0 ml $71.99 Merck & Co. VAQTA Pediatric 00006-4831-41 10 x 0.5 0.5 ml $36.44 GlaxoSmithKline Havrix Ped—syringe 58160-0825-52 10 x 1 0.5 ml $34.34 GlaxoSmithKline Havrix Pediatric 58160-0825-11 10 x 1 0.5 ml $34.34 GlaxoSmithKline Havrix—syringe 58160-0826-46 5 x 1 1 ml $72.68 GlaxoSmithKline Havrix 58160-0826-11 10 x 1 1 ml $72.68 Varicella Virus Vaccine: Merck & Co. Varivax 00006-4826-00 each 0.5 ml $105.29 Merck & Co. Varivax 00006-4827-00 10 x 1 0.5 ml $100.38 Merck & Co. Zostavax 00006-4963-00 each 19400 pfu $193.80 Merck & Co. Zostavax 00006-4963-41 10 x 1 19400 pfu $184.72 Human Papilloma Virus Vaccine: Merck & Co. Gardasil 00006-4045-00 each 0.5 ml $156.50 Merck & Co. Gardasil 00006-4045-41 10 x 1 0.5 ml $156.18 Merck & Co. Gardasil—syringe 00006-4109-06 6 x 1 0.5 ml $158.00 Merck & Co Gardasil—syringe w/o needle 00006-4109-09 6 x 1 0.5 ml $158.00 GlaxoSmithKline Cervarix 58160-0830-11 10 x 1 0.5 ml $128.75 GlaxoSmithKline Cervarix—syringe 58160-0830-46 5 x 1 0.5 ml $128.75 Rotavirus Vaccine: Merck & Co. Rotateq 00006-4047-41 10 x 1 2 ml $83.35 GlaxoSmithKline Rotarix 58160-0805-11 10 x 1 1.0 ml $122.85 Influenza Virus Vaccine: Novartis Fluvirin 66521-113-02 10 x 1 0.5 ml $18.24 Novartis Fluvirin 66521-113-10 10 x 1 0.5 ml $14.81 Sanofi pasteur Fluzone 49281-0011-10 10 x 1 0.5 ml $15.58 Sanofi pasteur Fluzone 49281-0011-50 10 x 1 0.5 ml $15.58 Sanofi pasteur Fluzone 49281-0388-15 10 x 1 0.5 ml $14.01 Sanofi pasteur Fluzone Pediatric 49281-0111-25 10 x 1 0.25 ml $16.53 GlaxoSmithKline Fluarix 58160-0873-46 5 x 1 0.5 ml $15.75 MedImmune Flumist 66019-0108-10 10 x 1 0.2 ml $22.31 Merck & Co. Afluria 33332-0010-01 10 x 1 0.5 ml $13.05 Merck & Co. Afluria 33332-0111-10 Multidose 0.5 ml $12.15 Hepatitis B Vaccine (HEP-B): Merck & Co. Recombivax
HBHepatitis B
vaccine
(Recombinant)
Dialysis
Formulation00006-4992-00 each 1.0 ml $165.29 Merck & Co. Recombivax HB Pediatric 00006-4981-00 10 x 0.5 ml 0.5 ml $27.85 Merck & Co. Recombivax HB 00006-4995-00 1.0 ml 1.0 ml $71.64 Merck & Co. Recombivax HB 00006-4995-41 10 x 1.0 ml 1.0 ml $70.81 Merck & Co. Recombivax HB syringe 00006-4094-31 1.0 ml 1.0 ml $73.31 Merck & Co. Recombivax HB syringe 00006-4094-06 6 x 1.0 ml 1.0 ml $73.31 Merck & Co Recombivax HB syringe w/o needle 00006-4094-09 6 x 1.0 ml 1.0 ml $73.31 GlaxoSmithKline Engerix-B Pediatric 58160-0820-11 10 x 1 0.5 ml $25.49 GlaxoSmithKline Engerix-B Pediatric 58160-0820-46 5 x 1 0.5 ml $25.49 GlaxoSmithKline Engerix-B Pediatric 58160-0856-35 5 x 1 0.5 ml $25.49 GlaxoSmithKline Engerix-B syringe 58160-0821-51 10 x 1 1.0 ml $62.85 GlaxoSmithKline Engerix-B syringe 58160-0821-11 10 x 1 1.0 ml $62.85 Hepatitis B / HIB: Merck & Co. COMVAX 00006-4898-00 10 x 0.5 ml 0.5 ml $52.27 Hepatitis A & Hepatitis B Vaccine: GlaxoSmithKline Twinrix 58160-0815-11 10 x 1.0 1.0 ml $103.43 GlaxoSmithKline Twinrix—syringe 58160-0815-46 5 x 1.0 1.0 ml $103.43 Pneumococcal Vaccine: Pfizer Prevnar 13 0005-1971-02 10 x 1 0.5 ml $141.75 Merck & Co. Pneumovax 23 00006-4739-00 2.5 ml 0.5 ml $60.20 Merck & Co. Pneumovax 23 00006-4943-00 10 x 1 0.5 ml $67.58 Measles, Mumps, Rubella, and Varicella Vaccine Merck & Co. ProQuad 00006-4999-00 10 x 0.5 0.5 ml $160.12
Source The provisions of this Appendix H adopted February 3, 1995, effective February 4, 1995, 25 Pa.B. 511; amended August 16, 1996, effective August 17, 1996, 26 Pa.B. 3958; amended August 10, 2001, effective August 11, 2001, 31 Pa.B. 4498; amended October 25, 2002, effective October 26, 2002, 32 Pa.B. 5352; amended March 14, 2003, effective March 15, 2003, 33 Pa.B. 1418; amended April 16, 2004, effective April 17, 2004, 34 Pa.B. 2135; amended September 16, 2005, effective September 17, 2005, 35 Pa.B. 5190; amended January 19, 2007, effective January 20, 2007, 37 Pa.B. 372; amended December 21, 2007, effective December 22, 2007, 37 Pa.B. 6851; amended February 27, 2009, effective February 28, 2009, 39 Pa.B. 1167; amended February 5, 2010, effective February 6, 2010, 40 Pa.B. 760; amended September 17, 2010, effective September 18, 2010, 40 Pa.B. 5404; amended March 4, 2011, effective March 5, 2011, 41 Pa.B. 1263; amended October 28, 2011, effective October 29, 2011, 41 Pa.B. 5821. Immediately preceding text appears at serial pages (356175) to (356181).
Cross References This appendix cited in 31 Pa. Code § 89.807 (relating to immunizing agents, doses and AWPs).
APPENDIX I
DISCLOSURE STATEMENTSINSTRUCTIONS FOR USE OF THE DISCLOSURE
STATEMENTS FOR HEALTH INSURANCE POLICIES
SOLD TO MEDICARE BENEFICIARIES THAT
DUPLICATE MEDICARE
1. Section 1882 (d) of the Federal Social Security Act (42 U.S.C.A. § 1395ss) prohibits the sale of health insurance policies (the term policy or policies includes certificates) that duplicate Medicare benefits unless it will pay benefits without regard to other health coverage and it includes the prescribed disclosure statement on or together with the application for the policy.
2. All types of health insurance policies that duplicate Medicare shall include one of the attached disclosure statements, according to the particular policy type involved, on the application or together with the application. The disclosure statement may not vary from the attached statements in terms of language or format (type size, type proportional spacing, bold character, line spacing, and usage of boxes around text).
3. State and Federal law prohibits insurers from selling a Medicare supplement policy to a person that already has a Medicare supplement policy except as a replacement.
4. Property/Casualty and Life insurance policies are not considered health insurance.
5. Disability income policies are not considered to provide benefits that duplicate Medicare.
6. Long-term care policies are insurance policies that coordinate with Medicare and other health insurance are not considered to provide benefits that duplicate Medicare.
7. The Federal law does not preempt state laws that are more stringent than the Federal requirements.
8. The Federal law does not preempt existing state form filing requirements.
9. Section 1882 of the Social Security Act was amended in subsection (d)(3)(A) to allow for alternative disclosure statements. The disclosure statements already in Appendix I remain. Carriers may use either disclosure statement with the requisite insurance product. However, carriers should use either the original disclosure statements or the alternative disclosure statements and not use both simultaneously.
(Original disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.)
Important Notice to Persons on Medicare THIS INSURANCE DUPLICATES SOME
MEDICARE BENEFITS
This is not Medicare Supplement Insurance This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it pays:• hospital or medical expenses up to the maximum stated in the policy
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• other approved items and services
Before You Buy This Insurance
Check the coverage in all health insurance policies you already have.
(Original disclosure statement for policies that provide benefits for specified limited services.)
Important Notice to Persons on Medicare
THIS INSURANCE DUPLICATES SOME
MEDICARE BENEFITS
This is not Medicare Supplement Insurance This insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when:• any of the services covered by the policy are also covered by Medicare
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• other approved items and services
Before You Buy This Insurance
(Original disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.)
Important Notice to Persons on Medicare
THIS INSURANCE DUPLICATES
SOME MEDICARE BENEFITS
This is not Medicare Supplement Insurance This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses only when you are treated for one of the specific diseases or health conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it pays:• hospital or medical expenses up to the maximum stated in the policy
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice
• other approved items and services
Before You Buy This Insurance
(Original disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.)
Important Notice to Persons on Medicare
THIS INSURANCE DUPLICATES SOME
MEDICARE BENEFITS
This is not Medicare Supplement Insurance This insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits because Medicare generally pays for most of the expenses for the diagnosis and treatment of the specific conditions or diagnoses named in the policy.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice
• other approved items and services
Before You Buy This Insurance
(Original disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.)
Important Notice to Persons on Medicare
THIS INSURANCE DUPLICATES SOME
MEDICARE BENEFITS
This is not Medicare Supplement Insurance This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when:• any expenses or services covered by the policy are also covered by Medicare
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice
• other approved items and services
Before You Buy This Insurance
(Original disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.)
Important Notice to Persons on Medicare THIS INSURANCE DUPLICATES SOME
MEDICARE BENEFITS
This is not Medicare Supplement Insurance This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when:• any expenses or services covered by the policy are also covered by Medicare; or
• it pays the fixed dollar amount stated in the policy and Medicare covers the same event
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice care
• other approved items & services
Before You Buy This Insurance
(Original disclosure statement for other health insurance policies not specifically identified in the preceding statements.)
Important Notice to Persons on Medicare
THIS INSURANCE DUPLICATES SOME
MEDICARE BENEFITS
This is not Medicare Supplement Insurance This insurance provides limited benefits if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it pays:• the benefits stated in the policy and coverage for the same event is provided by Medicare
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice
• other approved items and services
Before You Buy This Insurance
(Alternative disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.)
Important Notice to Persons on Medicare
THIS IS NOT MEDICARE SUPPLEMENT
INSURANCE
Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
• hospitalization
• physician services
• other approved items and services
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
(Alternative disclosure statement for policies that provide benefits for specified limited services.)
Important Notice to Persons on Medicare
THIS IS NOT MEDICARE SUPPLEMENT
INSURANCE
Some health care services paid for by Medicare may also trigger the payment of benefits under this policy.This insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
• hospitalization
• physician services
• other approved items and services
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
(Alternative disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.)
Important Notice to Persons on Medicare
THIS IS NOT MEDICARE SUPPLEMENT
INSURANCE
Some health care services paid for by Medicare may also trigger the payment of benefits from this policy. Medicare generally pays for most or all of these expenses.This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses only when you are treated for one of the specific diseases or health conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice
• other approved items and services
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
(Alternative disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.)
Important Notice to Persons on Medicare
THIS IS NOT MEDICARE SUPPLEMENT
INSURANCE
Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.This insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice
• other approved items and services
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
Alternative disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.)
Important Notice to Persons on Medicare
THIS IS NOT MEDICARE SUPPLEMENT
INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.
This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
• hospitalization
• physician services
• hospice
• other approved items and services
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
(Alternative disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.)
Important Notice to Persons on Medicare
THIS IS NOT MEDICARE SUPPLEMENT
INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.
This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice care
• other approved items & services
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
(Alternative disclosure statement for other health insurance policies not specifically identified in the preceding statements.)
Important Notice to Persons on Medicare
THIS IS NOT MEDICARE SUPPLEMENT
INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.
This insurance provides limited benefits if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:• hospitalization
• physician services
• hospice
• other approved items and services
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
Source The provisions of this Appendix I adopted May 10, 1996, effective May 11, 1996, 26 Pa.B. 2196; amended January 8, 1999, effective January 9, 1999, 29 Pa.B. 172. Immediately preceding text appears at serial pages (218640) and (214691) to (214698).
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