§ 67.45. Nondiscrimination in availability of approved EMB coverage.
Insurers shall make available to an applicant or policyholder all levels of extraordinary medical benefit coverage approved for use by the Department.
Source The provisions of this § 67.45 adopted May 19, 1989, effective May 8, 1989, 19 Pa.B. 2178.
Source The provisions of this Appendix A adopted May 19, 1989, effective May 8, 1989, 19 Pa.B. 2178.
Cross References This section cited in 31 Pa. Code § 67.42 (relating to phase-in extraordinary medical benefit coverage).
APPENDIX B
Section
1761. Definitions (Repealed).
1762. Funding (Repealed).
1766. Benefits (Repealed).
Source The provisions of this Appendix B adopted October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482.
§ 1761. Definitions (Repealed).
The following words and phrases when used in this subchapter shall have the meanings given to them in this section unless the context clearly indicates otherwise:
‘‘Administrator.’’—The administrator designated by the Catastrophic Loss Trust Fund Board.
‘‘Board.’’—The Catastrophic Loss Trust Fund Board.
‘‘Catastrophic loss.’’—An injury, arising out of the maintenance or use of a motor vehicle, for which the reasonable and necessary expenses for medical treatment and rehabilitative services, as described in section 1712(1) (relating to availability of benefits), exceed $100,000.
‘‘Catastrophic loss benefit.’’—Payments by the Catastrophic Loss Trust Fund for those reasonable and necessary expenses only for medical treatment and rehabilitative services which, as described in section 1712(1), exceed $100,000, subject to the limitations provided in section 1766 (relating to benefits). Catastrophic loss benefits shall not duplicate any other payments for medical treatment and rehabilitative services.
‘‘Eligible claimant.’’—Except as provided in the definition of ineligible claimant, eligible claimant includes a resident of this Commonwealth who suffers injury on or after the effective date of this subchapter arising out of the maintenance or use of a motor vehicle in the United States, its territories or possessions and Canada. The estate of an eligible claimant shall be entitled to receive catastrophic loss benefits pursuant to section 1766 to the extent that financial obligations for reasonable and necessary medical treatment and rehabilitative services were incurred by the eligible claimant prior to the death of that person. Otherwise eligible claimants shall not be disqualified from participating in or receiving benefits from the Catastrophic Loss Trust Fund for injuries suffered after the effective date of this subchapter but prior to their first registration renewal after the effective date of this subchapter.
‘‘Executive director.’’—The executive director of the Catastrophic Loss Trust Fund Board.
‘‘Fund.’’—The Catastrophic Loss Trust Fund.
‘‘Fund charge.’’—The fund charge established under this subchapter.
‘‘Ineligible claimant.’’—Any of the following:(1) A person who is the owner of a motor vehicle who has not complied with the registration requirements of Chapter 13 (relating to registration of vehicles).
(2) A person who is the driver or occupant of a recreational vehicle not intended for highway use, a motorcycle, a motorized pedalcycle, a motor-driven cycle or like type vehicle required to be registered under this title but not subject to the charge levied in section 1762 (relating to funding).
‘‘Manager.’’—The manager designated by the Catastrophic Loss Trust Fund Board.§ 1762. Funding (Repealed).
The Catastrophic Loss Trust Fund shall be funded by levying an initial charge of $5 upon all motor vehicles required to be registered under Chapter 13 (relating to registration of vehicles) except trailers, recreational vehicles not intended for highway use, motorcycles, motor-driven cycles, motorized pedalcycles or like type vehicles. This charge shall be remitted to an insurance company or other party as may be designated by the Insurance Department. Upon receipt of the charge, the insurance company or other designated party shall remit it to the Insurance Department for deposit in the trust fund. The Catastrophic Loss Trust Fund Board shall by regulation determine by January 1 of each calendar year the amount of the fund charge for each registration year subsequent to the initial registration year and shall notify the Insurance Department which shall notify the insurance companies or other designated parties to collect the charge.
§ 1766. Benefits (Repealed).
(a) General rule.—Subject to the limitations set forth in subsection (b), the Catastrophic Loss Trust Fund shall provide catastrophic loss benefits to eligible claimants only for the payment of expenses for medical treatment and rehabilitative services in excess of $100,000. No payment shall be made by the fund for the first $100,000 of expense for medical treatment and rehabilitative services incurred by an eligible claimant.
(b) Maximum benefit.—The maximum catastrophic loss benefit which shall be paid by the fund on behalf of any one eligible claimant shall be $50,000 per year and $1,000,000 lifetime aggregate. During the first 18 months of eligibility, the administrator may approve payments on behalf of a claimant without regard to the $50,000 per year limit but subject to the $1,000,000 lifetime aggregate.
(c) Effect of other benefits.—Except for workers’ compensation, catastrophic loss benefits paid or payable by the fund shall be primary to any other available source of accident or health benefits including any program, group contract or other private or public source of benefits unless the law authorizing or providing those benefits makes the benefits primary to the benefits provided under this subchapter.
(d) Structured settlements.—The administrator may enter into structured settlements to pay benefits under this subchapter. Where it appears the settlement will be both cost effective to the fund and in the best interest of the claimant, the restrictions in subsection (b) shall not apply to this subsection, but in no event shall the cost of the structured settlement exceed the present value of the future annual payments up to the maximum lifetime aggregate benefit remaining calculated at 6% simple interest.
(e) Preclusion of pleading, proving and recovering benefits.—In any action for damages against a tortfeasor arising out of the maintenance or use of a motor vehicle, a person who is eligible to receive catastrophic loss benefits shall be precluded from pleading, introducing into evidence or recovering the amount of medical and rehabilitative expenses for which catastrophic loss benefits were paid or are payable. This preclusion applies only to catastrophic loss benefits.
(f) Subrogation.—There shall be no subrogation or reimbursement from a claimant’s tort recovery with respect to catastrophic loss benefits.
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