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The Vermont Statutes Online



Title

08

:
Banking and Insurance






Chapter

154

:
LONG-TERM CARE INSURANCE











 

§

8086. Preexisting conditions

(a) No long-term

care insurance policy or certificate 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 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.

(c) The

Commissioner may by rule extend the limitation periods established in subsections

(a) and (b) of this section 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) 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 (b) of this section. (Added 2003, No. 124 (Adj. Sess.), § 2, eff.

Jan. 1, 2005.)