[§431:10H-108] Preexisting
conditions--group and individual policies. (a) No long-term care
insurance policy or certificate other than a policy or certificate thereunder
issued to a group as defined in paragraph (1) of the definition of "group
long-term care insurance" in section 431:10H-104 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.
(b) No long-term care insurance policy or
certificate other than a policy or certificate thereunder issued to a group as
defined in paragraph (1) of the definition of "group long-term care
insurance" in section 431:10H-104 may exclude coverage for a loss or
confinement which 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.
(c) The commissioner may extend the limitation
periods in subsections (a) and (b) as to specific age group categories in
specific policy forms upon findings that the extension is in the best interest
of the public.
(d) 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 subsection (b) 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 (b). [L 1999, c 93, pt of §2]