Section 500.3905 - Long-term care coverage; requirements; certain coverages requiring care recommendations.
THE INSURANCE CODE OF 1956 (EXCERPT)
Act 218 of 1956
500.3905 Long-term care coverage; requirements; certain coverages requiring care recommendations.
Sec. 3905.
(1) Long-term care coverage shall meet all of the following requirements:
(a) Shall include coverage for intermediate/basic care, which shall not be significantly less than the coverage provided for skilled nursing care.
(b) Shall not limit or exclude coverage by type of illness, type of provider, territorial limitations, treatment, medical condition, or accident other than a motor vehicle accident, except as follows:
(i) Preexisting conditions.
(ii) Mental or nervous disorders; however, this shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder and shall not permit exclusion or limitation of benefits on the basis of Alzheimer's disease or related disorders.
(iii) Alcoholism or drug addiction.
(iv) Illness, treatment, or medical condition arising out of any of the following:
(A) War or act of war, whether declared or undeclared.
(B) Participation in a felony, riot, or insurrection.
(C) Service in the armed forces or units auxiliary to the armed forces.
(D) Suicide, whether or not the individual was sane or insane at the time of the suicide, attempted suicide, or intentionally self-inflicted injury.
(2) Long-term care coverage other than home care coverage may provide that before certain coverages in the policy take effect, care must first be recommended by a person or persons as provided in the policy and approved by the commissioner or prescribed by a licensed treating physician. Long-term care coverage for home care may provide that before coverage for home care in the policy takes effect, care must first be prescribed or recommended by a person or persons as provided in the policy and approved by the commissioner.
History: Add. 1992, Act 84, Imd. Eff. June 2, 1992
Popular Name: Act 218