44-4513. Policy; certificate; restrictions.

(1) No long-term care insurance policy may:

(a) Be canceled, refused renewal, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder;

(b) Contain a provision establishing a new waiting period in the event 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; or

(c) 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.

(2) No long-term care insurance policy or certificate, other than a policy or certificate thereunder issued to a group as defined in subdivision (1) of section 44-4508, shall use a definition of preexisting condition which is more restrictive than the following: Preexisting condition shall mean 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.

(3) No long-term care insurance policy or certificate, other than a policy or certificate thereunder issued to a group as defined in subdivision (1) of section 44-4508, 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.

(4) The director may extend the limitation periods set forth in subsections (2) and (3) of this section as to specific age group categories in specific policy forms upon finding that the extension is in the best interest of the public.

(5) The definition of preexisting condition shall 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 such 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 subsection (3) of this section expires. No long-term care insurance policy or certificate 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 subsection (3) of this section.

(6) No long-term care insurance policy may be delivered or issued for delivery in this state if such policy:

(a) Conditions eligibility for any benefits on a prior hospitalization requirement;

(b) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or

(c) Conditions eligibility for any benefits other than waiver of premium, postconfinement, postacute care, or recuperative benefits on a prior institutionalization requirement.

(7)(a) A long-term care insurance policy containing postconfinement, postacute care, or recuperative benefits shall clearly label in a separate paragraph of the policy or certificate entitled Limitations or Conditions on Eligibility for Benefits such limitations or conditions, including any required number of days of confinement.

(b) A long-term care insurance policy which conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty days.

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