State RegulationsPA specificDifficulty 1/5
Which Pennsylvania regulations govern pre-existing condition provisions in group health insurance policies?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Pennsylvania's group health pre-existing condition rules live at 31 Pa. Code 89.402 through 31 Pa. Code 89.406, within the group health chapter the Pennsylvania Insurance Department administers. These sections govern when and how a group policy may limit coverage for conditions that existed before the member's effective date. The individual limited-policy exclusion rules in the 88 chapter are a separate framework.
Why the other options are wrong
- A) 31 Pa. Code 88.84 and 31 Pa. Code 88.51 belong to individual limited health policies, not the group pre-existing framework.
- B) 31 Pa. Code 88.101 through 31 Pa. Code 88.103 govern individual health replacement, not group pre-existing conditions.
- D) 31 Pa. Code 146.5 and 31 Pa. Code 146 are unfair claims settlement rules, unrelated to underwriting limitations.
Memory hook
Group pre-existing: the 89.40x block of Pennsylvania's rules.