"Preexisting Condition" Defined; Exclusion of Coverage; Limitations

Checkout our iOS App for a better way to browser and research.

Sec. 10. (a) As used in this section, "preexisting condition" means the existence of:

(1) either:

(A) symptoms that would cause an ordinarily prudent person to seek diagnosis, care, or treatment; or

(B) a condition for which medical advice or treatment was recommended by, or received from, a provider of health care services; within

(2) a period not to exceed either:

(A) twelve (12) months preceding the effective date of coverage of an insured person who is sixty-five (65) years of age or older on the effective date of coverage; or

(B) twenty-four (24) months preceding the effective date of coverage of an insured person who is less than sixty-five (65) years of age on the effective date of coverage.

(b) A long term care insurance policy may exclude coverage for a loss or confinement that is the result of a preexisting condition only if that loss or confinement begins within:

(1) twelve (12) months following the effective date of coverage of an insured person who is sixty-five (65) years of age or older on the effective date of coverage; or

(2) twenty-four (24) months following the effective date of coverage of an insured person who is under sixty-five (65) years of age on the effective date of coverage.

(c) The insurance commissioner may extend the limitation periods set forth in subsections (a)(2)(A), (a)(2)(B), and (b), concerning specific age group categories in specific policies upon a finding that the extension is in the best interest of the public.

As added by P.L.275-1987, SEC.1.


Download our app to see the most-to-date content.