Pennsylvania's senior-market rules come from two sources:

• Medicare supplement regulations in 31 Pa. Code Chapter 89 (89.770 and following).
• The Long-Term Care Insurance Act (40 P.S. 991.1101 et seq.), with its regulations in 31 Pa. Code Chapter 89a.

Expect questions on free looks, outlines of coverage, preexisting-condition limits, replacement credit, commission limits, and LTC protections such as the ban on prior-hospitalization requirements. How Medicare itself works (Parts A-D, enrollment, Medigap plan letters, Medicaid, LTC benefit triggers) is in the national Senior and Special Needs guide.

Medicare supplement (31 Pa. Code Ch. 89)

Standard plans and open enrollment

• Policies must follow the standardized benefit plans (89.777, 89.777b).
• Open enrollment lasts 6 months, beginning with the first month the person is enrolled in Medicare Part B (89.778).

Outline and free look (89.783)

• The producer gives the outline of coverage at application and gets a signed acknowledgment.
• Free look: 30 days for a full refund.

Preexisting conditions and replacements

• A policy may not exclude losses from a preexisting condition incurred more than 6 months after the effective date (89.776a).
• Replacement (89.789): the new issuer credits time already served. If the old policy was in force at least 6 months, no new preexisting or waiting periods apply to similar benefits.

Guaranteed issue (89.790)

• After losing employer group coverage, a beneficiary generally has 63 days of guaranteed issue. The period runs from the later of the termination notice or the end of coverage.

Marketing rules

• No duplicate coverage: selling more than one Medicare supplement policy to the same person is prohibited (89.787).
• Cold lead advertising is prohibited. Example: a mailer that hides the fact that an agent will contact the respondent (89.786(b)).
• Commission: first-year commission is capped at 200% of the second-year commission (89.782).

Long-term care insurance (40 P.S. 991.1101 et seq.; 31 Pa. Code Ch. 89a)

Policy standards

• Minimum coverage: a policy can't be marketed as LTC insurance if it is designed to cover less than 12 consecutive months (991.1105(b)(4)).
• No cancellation for age or health: a policy can't be canceled or nonrenewed because of the insured's age or declining health (991.1105(b)).
• Preexisting conditions: a loss can be excluded only if it begins within 6 months after the effective date (991.1105(c)).
• No prior-stay requirement: benefits can't depend on a prior hospital or institutional stay. The only exceptions are waiver of premium and post-confinement, post-acute or recuperative benefits (991.1108).

Free look and disclosure

• Free look: 30 days (991.1110).
• At solicitation the applicant receives a Shopper's Guide and the outline of coverage. In a producer sale, the outline comes before the application is presented (991.1111).
• Before an application is considered, the applicant completes a personal worksheet and receives the "Things You Should Know Before You Buy" disclosure (89a.121).

Lapse protection (89a.106)

• Before the policy is issued, the applicant names a third party to receive lapse notices, or signs a waiver.
• A policy that lapses because a cognitively impaired insured missed premiums must be reinstated if requested within 5 months.

Inflation protection and nonforfeiture

• Insurers must offer inflation protection compounded at least 5% a year (89a.112).
• If the applicant rejects the nonforfeiture offer, a contingent benefit upon lapse still applies. It is triggered when premiums rise by a set percentage (based on issue age) and the policy lapses within 120 days (89a.123).

Tax-qualified contracts (89a.125)

• The insured is chronically ill if unable to perform at least two activities of daily living for at least 90 days, or severely cognitively impaired.

Producer compensation and penalties

• First-year compensation is capped at 50% of the first-year premium. Renewal compensation is capped at 10% for at least 5 years (89a.129).
• A producer who violates the LTC marketing rules faces a civil penalty of up to the greater of three times the commissions on each policy or $10,000 (991.1114).
• Training: an initial LTC course, then 4 hours in each later 24-month cycle (31 Pa. Code 39a.9).

Partnership

• The Long-Term Care Partnership Program lets qualifying policyholders protect assets from Medicaid spend-down, dollar for dollar for benefits paid (991.1110.1).

Guaranty protection

• The Pennsylvania Life and Health Insurance Guaranty Association covers LTC benefits up to $300,000 (40 P.S. 991.1703).

Common exam traps

• Free looks: Medigap 30 days; LTC 30 days. The Pennsylvania LTC free look is not 10 days.
• Medigap open enrollment: 6 months from Part B enrollment. Guaranteed issue after losing employer coverage: 63 days.
• Preexisting limits: 6 months for both Medigap and LTC.
• LTC can't require a prior hospital stay.
• Inflation protection offer: at least 5% compounded.
• Compensation caps: Medigap first year 200% of second year; LTC first year 50% of first-year premium.