Sec. 10.5. (a) As used in this section, "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 (6) months preceding the effective date of coverage of an insured individual.
(b) A long term care insurance policy may not use a definition of preexisting condition that is more restrictive than the definition contained in subsection (a).
(c) Except for a group long term care policy under IC 27-8-5-16(1) or IC 27-1-12-37, a long term care insurance policy 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 (6) months following the effective date of coverage of an insured individual.
(d) The commissioner may extend the limitation period under subsections (a) and (c) concerning a specific age group category in a specific policy form upon a finding by the commissioner that the extension is in the best interest of the public.
(e) This section does not prohibit an insurer from doing any of the following:
(1) Using an application form designed to elicit the complete health history of an applicant.
(2) Based on an application, underwriting in accordance with the insurer's established underwriting standards.
(f) Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether the condition is disclosed on the application, need not be covered until after the waiting period described in subsection (c).
(g) A long term care insurance policy may not exclude or use a waiver or rider to exclude, limit, or reduce coverage or benefits for a specifically named or described preexisting disease or physical condition beyond the waiting period described in subsection (c).
As added by P.L.114-1991, SEC.12.
Structure Indiana Code
Article 8. Life, Accident, and Health
Chapter 12. Long Term Care Insurance
27-8-12-1. "Applicant" Defined
27-8-12-2. "Certificate" Defined
27-8-12-3. "Certificate Holder" Defined
27-8-12-4. "Insurance Policy" Defined
27-8-12-4.5. "Long Term Care Facility" Defined
27-8-12-5. "Long Term Care Insurance Policy" Defined
27-8-12-6. Compliance With Statutory Requirements
27-8-12-7.1. Qualification of Long Term Care Policies; Rules
27-8-12-8. Loss Ratio Standards Rule
27-8-12-9. Termination of Policy on Grounds of Age or Deteriorated Health
27-8-12-10. "Preexisting Condition" Defined; Exclusion of Coverage; Limitations
27-8-12-10.6. Conditions on Eligibility for Benefits; Restrictions
27-8-12-11. Establishment of New Waiting Period
27-8-12-12. No Obligation Return Period; Notice
27-8-12-13. Direct Response Solicitation Issued Policies; No Obligation Return Period; Notice
27-8-12-14. Outline of Coverage; Contents
27-8-12-14.5. Policy Summary; Requirements
27-8-12-15. Group Policy Certificate; Contents
27-8-12-16. Application of General Insurance Law
27-8-12-17. Group Policies Issued in Another State; Requirements