North Carolina HB 721: Long-Term Care Insurance.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1989

H 1

HOUSE BILL 721*

Short Title: Long-Term Care Insurance. (Public)
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Sponsors: Representatives Wiser; Locks, Fussell, Buchanan, and Wood.
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Referred to: Commerce.
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March 20, 1989

A BILL TO BE ENTITLED 1
AN ACT TO IMPROVE COVERAGE UNDER LONG-TERM CARE INSURANCE. 2
The General Assembly of North Carolina enacts: 3
Section 1. G.S. 58-543(4) reads as rewritten: 4
"(4) ‘Long-term care insurance' means any policy, rider, or certificate advertised, 5
marketed, offered, or designed to provide coverage for not less than 12 consecutive 6
months for each covered person on an expense incurred, indemnity, prepaid, or other 7
basis, for one or more necessary or medically necessary diagnostic, preventive, 8
therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting 9
other than an acute care unit of a hospital. ‘Long-term care insurance' includes group 10
and individual policies insurance whether issued by insurers, fraternal benefit societies, 11
nonprofit health, hospital, and medical service corporations, prepaid health plans, health 12
maintenance organizations, or any similar organization. ‘Long-term care insurance' 13
does not include any policy insurance that is offered primarily to provide basic Medicare 14
supplement coverage, basic hospital expense coverage, basic medical-surgical expense 15
coverage, hospital confinement indemnity coverage, major medical expense coverage, 16
disability income protection coverage, accident only coverage, specified disease or 17
specified accident coverage, or limited benefit health coverage." 18
Sec. 2. G.S. 58-545(b) is amended by adding a new subdivision to read: 19
"(3) Provide coverage for skilled nursing care only or provide significantly 20
more coverage for skilled care in a facility than coverage for lower 21
levels of care." 22
Sec. 3. G.S. 58-545(c) reads as rewritten: 23
"(c) Pre-existing Preexisting condition: 24

GENERAL ASSEMBLY OF NORTH CAROLINA 1989
Page 2 HOUSE BILL 721* version 1
(1) No long-term care insurance, other than that issued to groups defined 1
in G.S. 58-543(3)a., policy or certificate shall use a definition of ‘pre-2
existing preexisting condition' that is more restrictive than the 3
following: pre-existing ‘Preexisting condition' means the existence of 4
symptoms that would cause an ordinarily prudent person to seek diagnosis, 5
care or treatment, or a condition for which medical advice or treatment 6
was recommended by, or received from a provider of health care 7
services, within the following limitation periods: 8
a. Six months preceding the effective date of coverage of an 9
insured person who is 65 years of age or older on the effective 10
date of coverage; or 11
b. Twenty-four months preceding the effective date of coverage of 12
an insured person who is under age 65 on the effective date of 13
coverage. six months preceding the effective date of coverage 14
of an insured person. 15
(2) No long-term care insurance policy may other than that issued to 16
groups defined in G.S. 58-543(3)a. shall exclude coverage for a loss or 17
confinement that is the result of a pre-existing preexisting condition 18
unless such loss or confinement begins with the following periods: 19
a. Six months following the effective date of coverage of an 20
insured person who is 65 years of age or older on the effective 21
date of coverage; or 22
b. Twenty-four months following the effective date of coverage of 23
an insured person who is under 65 on the effective date of 24
coveragewithin six months following the effective date of 25
coverage of an insured person. 26
(3) The Commissioner may extend the limitation periods set forth in 27
subdivisions (c)(1) and (2) of this section as to specific age group 28
categories in specific policy forms upon findings that the extension is 29
in the best interest of the public. 30
(4) The definition of ‘pre-existing preexisting condition' does not prohibit 31
an insurer from using an application form designed to elicit the 32
complete health history of an applicant, and, on the basis of the 33
answers on that application, from underwriting in accordance with that 34
insurer's established underwriting standards." 35
Sec. 4. G.S. 58-545(d) reads as rewritten: 36
"(d) No long-term care insurance policy that provides benefits only following 37
Prior hospitalization or institutionalization: shall condition such benefits upon 38
admission to a facility for the same or related conditions within a period of less than 30 39
days after discharge from the institution 40
(1) Effective September 1, 1989, no long-term care insurance may be 41
delivered or issued for delivery in this State if it: 42
a. Conditions eligibility for any benefits on a prior hospitalization 43
requirement; or 44

1989 GENERAL ASSEMBLY OF NORTH CAROLINA
HOUSE BILL 721* v