31A-22-1406 - Preexisting conditions.
31A-22-1406. Preexisting conditions.
(1) A long-term care insurance policy or certificate shall not use a definition of apreexisting condition which is more restrictive than the following: "Preexisting condition means acondition for which medical advice or treatment was recommended by or received from aprovider of health care services, within six months preceding the effective date of coverage of aninsured person."
(2) A long-term care insurance policy or certificate may not exclude coverage for a lossor confinement which is the result of a preexisting condition unless such loss or confinementbegins within six months following the effective date of coverage of an insured person.
(3) The commissioner may extend the preexisting condition periods provided inSubsections (1) and (2) as to specific age group categories in specific policy forms upon findingthat the extension is in the best interest of the public.
(4) (a) The definition of preexisting condition does not prohibit an insurer from using anapplication form designed to elicit the complete health history of an applicant and fromunderwriting in accordance with that insurer's established underwriting standards on the basis ofthe answers on that application.
(b) 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 waitingperiod described in Subsection (2) expires.
(c) A long-term care insurance policy or certificate may not exclude or use waivers orriders of any kind to exclude, limit, or reduce coverage or benefits for specifically named ordescribed preexisting diseases or physical condition beyond the waiting period described inSubsection (2).
Enacted by Chapter 243, 1991 General Session