State RegulationsPA specificDifficulty 3/5
A candidate is comparing how Pennsylvania treats pre-existing conditions in group health policies versus in individual limited health policies. Which comparison is correct?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Pennsylvania maintains two parallel frameworks: the group health chapter supplies the pre-existing condition rules at 31 Pa. Code 89.402 through 31 Pa. Code 89.406, while individual limited health policies rely on the exclusion list at 31 Pa. Code 88.84 and the definitional support of 31 Pa. Code 88.51. Neither framework is identical to the other, and neither categorically forbids pre-existing limitations in group coverage, as the Pennsylvania Insurance Department's chapter structure makes clear.
Why the other options are wrong
- A) The frameworks sit in different chapters with different sections; treating them as identical misstates Pennsylvania's structure.
- B) Group policies may contain pre-existing condition provisions under the group framework; they are not categorically forbidden.
- C) The advertising and unfair claims chapters govern other subjects entirely; pre-existing rules come from the group and individual health chapters.
Memory hook
Group = 89.40x; individual limited = 88.84 and 88.51. Two chapters, two toolkits.