Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

31 Pa. Code § 152.16. Preexisting condition limitation.

§ 152.16. Preexisting condition limitation.

 A risk-assuming preferred provider organization which is not a licensed insurer may not use a policy or contract which contains a preexisting condition limitation which is more restrictive than the following: a preexisting condition is a disease or physical condition for which medical advice or treatment has been received within 90 days immediately prior to becoming covered under the preferred provider arrangement. The condition is covered after the individual has been covered for more than 12 months under the group contract.

Cross References

   This section cited in 31 Pa. Code §  152.11 (relating to review of application by the Commissioner).

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