58-17B-6 Defining "preexisting conditions"--Requirements--Exclusions for loss or confinem...
Defining "preexisting conditions"--Requirements--Exclusions for loss or
confinement--Extending limitation periods.
No long-term care insurance policy or certificate other
than a policy or certificate thereunder issued to a group as defined in subdivision 58-17B-2(4)(a):
Shall use a definition of "preexisting condition" which 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;
May 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 director may extend the limitation periods set forth herein as to specific age group categories
in specific policy forms upon findings that the extension is in the best interest of the public. The
definition of "preexisting condition" 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 that
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
subdivision (2) of this section expires. No long-term care insurance policy or certificates may
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 subdivision (2) of this section.
Source: SL 1989, ch 440, § 6.