North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-15 - Short-Term Care Insurance › Section 45-06-15-03 - Policy practices and provisions

Current through Supplement No. 393, July, 2024
1.
Guaranteed renewable for life - Limitation on preexisting conditions.
Any short-term care insurance policy or group certificate must be
				guaranteed renewable for life. For purposes of this section, "guaranteed
				renewable for life" means the insured has the right to continue the policy or
				group certificate for life subject to the policy's terms by the timely payment
				of premiums during which the insurer has no right to make unilaterally any
				change in any provision of the policy while the policy is in force. The insurer
				may, however, in accordance with the provisions of the policy, make changes in
				premium rates as to all insureds who are placed in the same class for purposes
				of rate determination in the process of issuance of the policy or group
				certificate.
A policy or certificate of insurance, providing benefits for
				  short-term care, which is sold to a consumer to replace a policy may not
				  contain any provision limiting payment of benefits due to preexisting
				  conditions of the insured except if there is any time period remaining relating
				  to the exclusion of coverage for preexisting conditions as specified in the
				  underlying policy that the remaining waiting period for coverage of preexisting
				  conditions shall apply to the new policy unless the policy otherwise
				  provides.
2.
Preexisting conditions.
a. No
				short-term care insurance policy or group certificate may define "preexisting
				condition" as more restrictive than meaning 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 short-term
				care insurance policy or certificate issued on a group short-term care
				insurance policy may exclude coverage for a loss or confinement that is the
				result of a preexisting condition unless the loss or confinement begins within
				six months following the effective date of coverage of an insured
				person.
c. The limitation on
				defining a 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
				subdivision b expires. No short-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 subdivision
				b.