§ 10-19-108 — Requirements for preexisting conditions

(1) A long-term care
insurance policy or certificate, other than a policy or certificate thereunder, issued
to a group as defined in section 10-19-103 (4)(a), shall not use a definition of
preexisting condition that is more restrictive than the following: Preexisting
condition means a condition for which medical advice or treatment was
recommended by or received from a provider of health-care services within six
months preceding the effective date of coverage of an insured person.

(2) A long-term care insurance policy or certificate, other than a policy or
certificate thereunder issued to a group as defined in section 10-19-103 (4)(a), shall
not exclude coverage for a loss or confinement which is the result of a preexisting
condition, unless such loss or confinement begins within six months following the
effective date of coverage of an insured person.

(3) The commissioner may extend the limitation periods set forth in
subsections (1) and (2) of this section to specific age group categories or specific
policy forms upon findings that the extension is in the best interest of the public.

(4) The definition of preexisting condition in subsection (1) of this section
does not prohibit an insurer from using an application form designed to elicit the
complete health history of an applicant and, on the basis of the answers on the
application, from underwriting in accordance with that insurer's established
underwriting standards. Unless otherwise provided in the policy or certificate, a
preexisting condition, regardless of whether it is disclosed on the application, need
not be covered until the waiting period described in subsection (2) of this section
expires. A long-term care insurance policy or certificate shall not exclude or use
waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for
specifically named or described preexisting diseases or physical conditions beyond
the waiting period described in subsection (2) of this section.

Legislative History

Source: L. 90: Entire article R&RE, p. 646, � 1, effective July 1. L. 95: (1) amended, p. 923, � 22, effective May 25. L. 2007: (1), (2), and (4) amended, p. 198, � 4, effective January 1, 2008.