Pennsylvania Code (Last Updated: April 5, 2016) |
Title 31. INSURANCE |
PART IV. Life Insurance |
Chapter 88. Individual Accident and Sickness Insurance Minimum Standards |
Section 88.52. Definitions
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The following words and terms, when used in these § § 88.5188.53, have the following meanings, unless the context clearly indicates otherwise:
Preexisting conditionA condition for which medical advice or treatment was recommended by a physician or received from a physician within a 5-year period preceding the effective date of the coverage of the insured person.
Notation
Construction; Ambiguity
The fact that State insurance regulations contain a definition of preexisting condition that is virtually identical to that contained in an insureds policy does not conclusively demonstrate that the policy definition is unambiguous. Lawson v. Fortis Insurance Co., 146 F. Supp.2d 737 (E.D. Pa. 2001); affirmed 301 F.3d 159 (3rd Cir. Pa. 2002).