TITLE 27
Insurance
CHAPTER 27-41
Health Maintenance Organizations
SECTION 27-41-81
§ 27-41-81 Prohibition on preexisting
condition exclusions.
(a) A health insurance policy, subscriber contract, or health plan offered,
issued, issued for delivery, or issued to cover a resident of this state by a
health insurance company licensed pursuant to this title and/or chapter:
(1) Shall not limit or exclude coverage for an individual
under the age of nineteen (19) by imposing a preexisting condition exclusion on
that individual.
(2) For plan or policy years beginning on or after January 1,
2014, shall not limit or exclude coverage for any individual by imposing a
preexisting condition exclusion on that individual.
(b) As used in this section:
(1) "Preexisting condition exclusion" means a limitation or
exclusion of benefits, including a denial of coverage, based on the fact that
the condition (whether physical or mental) was present before the effective
date of coverage, or if the coverage is denied, the date of denial, under a
health benefit plan whether or not any medical advice, diagnosis, care or
treatment was recommended or received before the effective date of coverage.
(2) "Preexisting condition exclusion" means any limitation or
exclusion of benefits, including a denial of coverage, applicable to an
individual as a result of information relating to an individual's health status
before the individual's effective date of coverage, or if the coverage is
denied, the date of denial, under the health benefit plan, such as a condition
(whether physical or mental) identified as a result of a pre-enrollment
questionnaire or physical examination given to the individual, or review of
medical records relating to the pre-enrollment period.
(c) This section shall not apply to grandfathered health
plans providing individual health insurance coverage.
(d) This section shall not apply to insurance coverage
providing benefits for: (1) Hospital confinement indemnity; (2) Disability
income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6)
Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily
injury or death by accident or both; and (9) Other limited benefit policies.
History of Section.
(P.L. 2012, ch. 256, § 10; P.L. 2012, ch. 262, § 10.)
