Section 89.99. Student accident and sickness insurance

(a) An application, enrollment form, policy, certificate or brochure used in lieu of a certificate, rider or endorsement may not be used, sold or issued until the forms of the same have been filed with and approved by the Insurance Commissioner.

(b) Applicable premium rates shall be filed with the Department.

(c) The insurer shall make known to every individual purchaser the applicable schedule of benefits, premium rates and claim filing procedures and advise where additional information and assistance relating to the benefits, rates and procedures may be obtained.

(d) Certificate or brochure used in lieu of a certificate shall set forth the essential features of the coverage, location of the claims office and instructions for filing claims and it shall be delivered or furnished for delivery to the individual purchaser.

(e) A provision excluding, limiting or coordinating benefits by reason of other insurance shall be set forth clearly in the policy, be accurately summarized in a certificate or brochure used in lieu of a certificate and in advertising material, and not be applied to the first $100 of any one claim.

(f) Prior to its initial use, material used in the direct solicitation of student accident insurance shall be submitted to the Department for review. Within 30 days from the date that the material is received by the Department, the insurer will be notified whether or not the Department has an objection to the same. Thereafter, amended material shall be promptly submitted to the Department; however, review prior to use will be required only in the event of substantial change.

(g) Advertising material and direct solicitation material prepared by an agent or broker shall be approved by the insurer prior to use. Material which differs substantially from that already submitted by the insurer to the Department for review shall be submitted under subsection (f).

(h) The insurer shall require an enrollment form to be signed by the parents, guardian or person in loco parentis of each student, except in the case of married or adult students, or where the participant is not required to make a premium contribution.

(i) An individual application or enrollment form shall clearly indicate that there is no obligation to purchase the insurance.

The provisions of this § 89.99 adopted October 23, 1970, effective October 24, 1970, 1 Pa.B. 435.