Sec. 3905.
(1) Long-term care coverage shall meet all of the following requirements:
(a) Shall include coverage for intermediate/basic care, which shall not be significantly less than the coverage provided for skilled nursing care.
(b) Shall not limit or exclude coverage by type of illness, type of provider, territorial limitations, treatment, medical condition, or accident other than a motor vehicle accident, except as follows:
(i) Preexisting conditions.
(ii) Mental or nervous disorders; however, this shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder and shall not permit exclusion or limitation of benefits on the basis of Alzheimer's disease or related disorders.
(iii) Alcoholism or drug addiction.
(iv) Illness, treatment, or medical condition arising out of any of the following:
(A) War or act of war, whether declared or undeclared.
(B) Participation in a felony, riot, or insurrection.
(C) Service in the armed forces or units auxiliary to the armed forces.
(D) Suicide, whether or not the individual was sane or insane at the time of the suicide, attempted suicide, or intentionally self-inflicted injury.
(2) Long-term care coverage other than home care coverage may provide that before certain coverages in the policy take effect, care must first be recommended by a person or persons as provided in the policy and approved by the commissioner or prescribed by a licensed treating physician. Long-term care coverage for home care may provide that before coverage for home care in the policy takes effect, care must first be prescribed or recommended by a person or persons as provided in the policy and approved by the commissioner.
History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218
Structure Michigan Compiled Laws
Chapter 500 - Insurance Code of 1956
Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)
218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955)
Section 500.3901 - Long-Term Care Insurance; Definitions.
Section 500.3902 - Offer of Long-Term Care Coverage by Subsidiary of Health Care Corporation.
Section 500.3908 - Long-Term Care Partnership Program Policy; Conversion or Replacement.
Section 500.3911 - Preexisting Condition; Limitation Period; Definition.
Section 500.3913 - Home Health Care Benefits.
Section 500.3915 - Certain Conditions Prohibited.
Section 500.3919 - Institutionalization; Extension of Benefits; Limitations.
Section 500.3929 - Increasing Premiums Prohibited; Conditions.
Section 500.3933 - Summary of Coverage.
Section 500.3935 - Statement Relating to Request for Additional Information.
Section 500.3937 - Shopper's Guide; Format; Providing to Applicants; Exception.
Section 500.3941 - Advertising; Filing Copy With Commissioner.
Section 500.3942a - Reporting Requirements; Agent Activities; Preparation of Report.
Section 500.3943 - Right to Return Policy; Notice; “Direct Response Solicitation” Defined.
Section 500.3945 - Violation; Penalty.
Section 500.3949 - Life and Long-Term Care Benefits; Marketing; Compliance.
Section 500.3953 - Disclosure Statement.
Section 500.3955 - Compliance With Chapter and Applicable Laws.