38.2-5204 - Preexisting conditions. - Virginia Statutes

§ 38.2-5204. Preexisting conditions.

A. No long-term care insurance policy or certificate shall use a definitionof "preexisting condition" which is more restrictive than the following:"preexisting condition" means the existence of symptoms which would causean ordinary prudent person to seek diagnosis, care or treatment, or acondition for which medical advice or treatment was recommended by, orreceived from a provider of health care services, within six months precedingthe effective date of coverage of an insured person.

B. No long-term care insurance policy may exclude coverage for a loss orconfinement which is the result of a preexisting condition for a period ofconfinement longer than six months following the effective date of coverageof an insured person.

C. The Commission may extend the limitation periods set forth in subsectionsA and B of this section as to specific age group categories or specificpolicy forms upon findings that the extension is in the best interest of thepublic.

D. The definition of "preexisting condition" does not prohibit an insurerfrom using an application form designed to elicit the complete health historyof an applicant, and, on the basis of the answers on that application,underwriting in accordance with that insurer's established underwritingstandards for long-term care insurance policies. Unless otherwise providedin the policy or certificate, a preexisting condition, regardless of whetherit is disclosed on the application, need not be covered until the waitingperiod described in subsection A or B expires. No long-term care insurancepolicy or certificate may exclude or use waivers or riders of any kind toexclude, limit, or reduce coverage or benefits for specifically named ordescribed preexisting diseases or physical conditions beyond the waitingperiod described in subsection A or B.

(1987, c. 586; 1990, c. 285.)