State RegulationsPA specificDifficulty 2/5
An applicant for a Pennsylvania limited health policy received treatment for a kidney disorder before applying. The insurer wants the policy to exclude that condition. Under Pennsylvania regulation, what may the insurer do?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
31 Pa. Code 88.84 permits limited health policies to exclude pre-existing conditions, and such exclusions operate through the policy's terms rather than through case-by-case approval. The exclusion must appear in the policy as issued. This is the Pennsylvania mechanism by which specified-disease and other limited policies limit their exposure to conditions that existed before coverage began, enforced through the Pennsylvania Insurance Department's chapter on limited policies.
Why the other options are wrong
- A) The regulation provides for exclusions, not a blanket bar on covering the condition; insurers need not decline every such applicant.
- B) An exclusion operates through the policy terms; a silent exclusion that never appears in the contract is not the Pennsylvania approach.
- C) The exclusion follows the regulation's terms; individual advance consent from the Pennsylvania Insurance Department is not the mechanism.
Memory hook
Pre-existing can be left out — but only by saying so in the policy.