(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.
A long-term care insurance policy or certificate, other than a policy or certificatethereunder 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.
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.
The definition of "preexisting condition" in subsection (1) of this section does notprohibit 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.
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.