20-1691.03. Limitations of long-term care insurance policies

497 words·~2 min read·/az/title-20/20-1691-03

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

A. No insurer may cancel, fail to renew or otherwise terminate a long-term care insurance policy solely on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder.

B. No long-term care insurance policy may contain a provision establishing any new waiting period if existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder.

C. A long-term care insurance policy shall provide coverage for at least twenty-four consecutive months for each covered person.

D. No preexisting condition limitation period in a long-term care insurance policy or certificate may exceed the following:

1. If not approved under paragraph 2, six months after the effective date of coverage of an insured for whom medical advice or treatment was recommended by, or received from, a health care services provider.

2. A period of time set by the director after the effective date of coverage of an insured who is a member of a designated group for which the director has found that a different limitation period is justified because the group is specially limited by age, group categories or other specific policy provisions and that the different limitation period will be a benefit to the certificate holders.

E. No long-term care insurance policy or certificate may use a definition of preexisting condition which is more restrictive than the definition prescribed in this article.

F. A long-term care insurance policy 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 periods allowed under subsection D.

G. 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.

H. No long-term care insurance policy or certificate issued on or after July 1, 1990 may provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care, or coverage that conditions eligibility for benefits for levels of care on the receipt of higher levels of care. In evaluating the requirements of this subsection, the director shall consider the amount of coverage provided based on aggregate days of care covered for lower levels of care when compared to days of care covered for skilled care.

I. A long-term care insurance policy or certificate, other than a policy or certificate that is issued to a group, may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person.