SECTION 3.3824. Preexisting Conditions Provisions

(a) No long-term care insurance policy or certificate issued under provisions of this subchapter may contain a provision which denies a claim for losses incurred more than six months from the effective date of coverage for a preexisting condition, as defined in §3.3804 of this title (relating to Definitions).

(b) The definition of 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 subsection (a) of this section expires. No long-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 subsection (a) of this section.

(c) Any long-term care insurance policy or certificate which replaces another long-term care policy or certificate shall contain provisions that waive any time periods applicable to preexisting conditions and probationary periods in the new long-term care policy or certificate for similar benefits to the extent that such time periods have been satisfied under the policy being replaced.

Source Note: The provisions of this §3.3824 adopted to be effective February 15, 1990, 15 TexReg 544; amended to be effective July 20, 1992, 17 TexReg 4769; amended to be effective May 8, 1997, 22 TexReg 3786