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).

Terms Used In Indiana Code 27-8-12-10.5

  • applicant: means :

    Indiana Code 27-8-12-1

  • certificate: means a document issued to a member of the group covered under a group insurance policy, which policy has been delivered or issued for delivery in Indiana, to signify that the individual named in the certificate is covered under the policy. See Indiana Code 27-8-12-2
  • insurance policy: means any policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in Indiana by an insurer, a fraternal benefit society, a nonprofit corporation, a health maintenance organization (as defined in IC 27-13-1-19), a limited service health maintenance organization (as defined in IC 27-13-34-4), a preferred provider arrangement, or any other organization. See Indiana Code 27-8-12-4
  • long term care insurance policy: means an insurance policy providing coverage for at least twelve (12) consecutive months for each covered person on an expense incurred, indemnity, prepaid, or other basis for one (1) or more necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care wing of a hospital. See Indiana Code 27-8-12-5
     (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.

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