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Pennsylvania Statutes Title 40 P.S. Insurance § 776.5. Outline of coverage

Current as of January 01, 2025 | Updated by Findlaw Staff

(a) In order to provide for full and fair disclosure in the sale of individual accident and health insurance policies or subscriber contracts of a health plan corporation or a nonprofit health service plan or certificates issued by fraternal benefit societies, except for supplemental policies sold on the debit plan, and except for riders or amendments to policies or contracts, no such policy or contract shall be delivered or issued for delivery in this State unless the outline of coverage described in subsection (b) either accompanies the policy or is delivered to the applicant at the time application is made.

(b) The Insurance Commissioner shall issue regulations prescribing the format and contents of the outline of coverage required by subsection (a). “Format” means style, arrangement, and overall appearance, including such items as the size, color and prominence of type and the arrangement of text and captions. The outline of coverage shall include, in a form understandable to a person of average intelligence and education:

(1) a statement identifying the applicable category or categories of coverage provided by the policy or contract as prescribed in section 4;  1

(2) a description of the principal benefits and coverage provided in the policy or contract;

(3) a statement of the exceptions, reductions and limitation contained in the policy or contract;

(4) a statement of the renewal provisions including any reservation by the insurer of a right to change premiums; and

(5) a statement that the outline is a summary of the policy or contract issued or applied for and that the policy or contract should be consulted to determine governing contractual provisions.

1 40 P.S. § 776.4.
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Cite this article: FindLaw.com - Pennsylvania Statutes Title 40 P.S. Insurance § 776.5. Outline of coverage - last updated January 01, 2025 | https://codes.findlaw.com/pa/title-40-ps-insurance/pa-st-sect-40-776-5/

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