Pennsylvania's uniform individual accident and sickness provisions are in 40 P.S. 753. Its minimum standards for individual policies, including disability income, are in 31 Pa. Code Chapter 88. Most of the deadlines follow the familiar pattern, but two differ from NAIC Model 180's current version:

• The time limit on certain defenses is 3 years.
• The statute still includes an insurer Cancellation provision.

What each provision does in general is in the national Individual Accident and Health Provisions guide.

Right to examine (40 P.S. 752(A)(10))

• An individual accident and health policy must give at least a 10-day free look.
• A policy returned within that time, to the insurer or the agent, is void from the beginning, and the premium is refunded.

Required provisions (40 P.S. 753(A))

Optional provisions (40 P.S. 753(B))

• Change of occupation: if the insured is hurt after moving to a more hazardous occupation, the insurer pays what the premium would have bought at the riskier class rate (753(B)(1)).
• Relation of earnings to insurance: benefits beyond earnings may be reduced. Total monthly benefits can't be cut below $200 or the total benefits, if less (753(B)(6)).
• Other insurance and coordination provisions help keep combined benefits from exceeding the loss (753(B)(4)-(5)).
• Cancellation: Pennsylvania's statute still lists this provision (753(B)(8)).
  • The insurer may cancel on at least 5 days' written notice and refunds unearned premium pro rata.
  • An insured who cancels gets a short-rate refund.
• Illegal occupation: no liability for a loss to which the insured's commission of or attempt to commit a felony, or an illegal occupation, contributed (753(B)(10)).

Dependent children (40 P.S. 752(A)(9))

• Coverage continues past the limiting age for an unmarried child who can't support themself because of a disability.
• Proof of incapacity is due within 31 days of the child reaching the limiting age.

Minimum standards (31 Pa. Code Chapter 88)

Permitted exclusions (88.84) include:

• Intentionally self-inflicted injury.
• War.
• Cosmetic surgery.
• Routine exams.
• Aviation, except as a fare-paying passenger on a commercial airline.

Guaranteed renewable means the insurer must renew to a stated age but may change premiums by class.

Replacement (88.101-88.104)

• The required notice tells the applicant they have 10 days to review the new policy without cost.
• The producer should compare preexisting-condition limits, waiting periods and benefits.

Disability income (88.137-88.167)

• Total disability: may be defined as being unable to do the insured's own occupation for the first 24 months, and after that any occupation.
• Residual disability: defined in relation to the insured's reduction in earnings.
• One elimination period: a policy with both total and partial disability benefits may require only one.
• Short benefit periods: a policy paying benefits for 1 year or less may have an elimination period of no more than 90 days.
• Minimum benefit period: disability income protection must pay for at least 6 months.

Guaranty protection

• The Pennsylvania Life and Health Insurance Guaranty Association covers disability income benefits up to $300,000, and health benefit plans up to $500,000 (40 P.S. 991.1703).

Common exam traps

• Time limit on certain defenses is 3 years in Pennsylvania, not 2.
• Grace: 7 / 10 / 31 days by premium mode.
• Free look: 10 days, void from the beginning.
• Insurer cancellation: 5 days' notice with a pro rata refund. The insured gets a short-rate refund.
• Disability: own occupation for 24 months, then any occupation. Residual disability is measured by lost earnings.