§ 1715. Availability of adequate limits.

521 words·~2 min read·/pa/title-75/chapter-17/1715

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)General rule.-- An insurer shall make available for purchase first party benefits as follows:

(1)For medical benefits, up to at least $100,000.

(1.1) For extraordinary medical benefits, from $100,000 to $1,100,000, which may be offered in increments of $100,000, as limited by subsection (d).

(2)For income loss benefits, up to at least $2,500 per month up to a maximum benefit of at least $50,000.

(3)For accidental death benefits, up to at least $25,000.

(4)For funeral benefits, $2,500.

(5)For combination of benefits enumerated in paragraphs (1), (2),

(3)and

(4)and subject to a limit on the accidental death benefit of up to $25,000 and a limit on the funeral benefit of $2,500, up to at least $177,500 of benefits in the aggregate or benefits payable up to three years from the date of the accident, whichever occurs first, provided that nothing contained in this subsection shall be construed to limit, reduce, modify or change the provisions of subsection (d).

(b)Higher or lower limits and additional benefits.-- Insurers may make available higher or lower limits or benefits in addition to those enumerated in subsection (a).

(c)Restriction on providing first party benefits.-- An insurer shall not issue or deliver a policy providing first party benefits in accordance with this subchapter unless the policy also contains coverage for liability in amounts at least equal to the limits required for financial responsibility.

(d)Limitations.-- The maximum medical benefit which shall be paid on behalf of any one eligible claimant under subsection (a)(1.1) shall be $50,000 per year and $1,000,000 lifetime aggregate of reasonable and necessary expenses only for medical treatment and rehabilitative services which, as described in section 1712(1) (relating to availability of benefits), exceed $100,000. During the first 18 months of eligibility, the insurer shall approve payments on behalf of a claimant without regard to the $50,000 per year limit but subject to the $1,000,000 lifetime aggregate.

(e)Other extraordinary medical benefits.-- Notwithstanding the requirement of subsection (a)(1.1), an insured may obtain the extraordinary medical benefits described in that subsection through any insurance contract, program or group arrangement.

(f)Determining adverse experience of an agent.-- For purposes of determining adverse experience of an agent, experience generated from extraordinary medical benefit coverage described in subsection (a)(1.1) shall be excluded.

(g)Voluntary pooling.-- Notwithstanding any other provisions of this act or the act of June 11, 1947 (P.L.538, No.246), known as The Casualty and Surety Rate Regulatory Act, two or more insurers may enter into an arrangement or agreement to provide for the availability of an extraordinary medical benefit pursuant to the provisions of this chapter. All such arrangements or agreements entered into by an insurer shall be subject to the prior approval of the Insurance Commissioner.

75c1715v

(Feb. 12, 1984, P.L.53, No.12, eff. Oct. 1, 1984; Apr. 26, 1989, P.L.13, No.4, eff. June 1, 1989; Feb. 7, 1990, P.L.11, No.6, eff. July 1, 1990)

1990 Amendment. Act 6 amended subsec. (a).

Cross References. Section 1715 is referred to in sections 1719, 1720, 1723, 1787, 1791, 1798.1, 1798.3 of this title.

75c1716s