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23-97-308. Preexisting condition.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-97-308. Preexisting condition.
(a) No long-term care insurance policy or certificate other than a policy or certificate issued to a group approved by the Insurance Commissioner under § 23-97-304(6)(B) shall:
(1) Use a definition of “preexisting condition” that is more restrictive than the following: “Preexisting condition” means a condition for which medical advice or treatment was recommended by or received from a provider of healthcare services within six (6) months preceding the effective date of coverage of an insured person; or
(2) 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 person.
(b) The commissioner may extend the limitation periods set forth in subsection (a) of this section for specific age group categories in specific policy forms upon finding that the extension is in the best interest of the public.
(c)(1) 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 when underwriting in accordance with the insurer's established underwriting standards.
(2) 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 (a)(2) of this section expires.
(3) 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 subdivision (a)(2) of t
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-97-308
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. A text match is a research starting point; applicability is not established.
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Stable record: arkansas_code:legal_authorities:23-97-308
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 26465019b94fcf8bc9d6d569ec6ca1eed3ac1edc0fffc4e8624cc684f7b13f6b
Source location: content.xml paragraph 57954
Stored source content
23-97-308. Preexisting condition.
(a) No long-term care insurance policy or certificate other than a policy or certificate issued to a group approved by the Insurance Commissioner under § 23-97-304(6)(B) shall:
(1) Use a definition of “preexisting condition” that is more restrictive than the following: “Preexisting condition” means a condition for which medical advice or treatment was recommended by or received from a provider of healthcare services within six (6) months preceding the effective date of coverage of an insured person; or
(2) 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 person.
(b) The commissioner may extend the limitation periods set forth in subsection (a) of this section for specific age group categories in specific policy forms upon finding that the extension is in the best interest of the public.
(c)(1) 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 when underwriting in accordance with the insurer's established underwriting standards.
(2) 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 (a)(2) of this section expires.
(3) 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 subdivision (a)(2) of this section.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-97-304. Definitions.
As used in this subchapter:
(1) “Applicant” means:
(A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and
(B) In the case of a group long-term care insurance policy, the proposed certificate holder;
(2) “Association” means a professional, trade, or occupational association or associations, if the association:
(A) Is composed entirely of individuals that are or were actively engaged in the same profession, trade, or occupation; and
(B) Has been maintained in good faith for purposes other than obtaining insurance;
(3) “Certificate” means any certificate issued under a group long-term care insurance policy delivered or issued for delivery in this state;
(4) “Commissioner” means the Insurance Commissioner;
(5) “Federally tax-qualified long-term care insurance contract” means:
(A) An individual or group insurance contract that meets the following requirements of section 7702B(b) of the Internal Revenue Code of 1986:
(i)(a) The only insurance protection provided under the contract is coverage of qualified long-term care services.
(b) A contract satisfies the requirements of this subdivision (5)(A)(i) even though payments are made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate;
(ii)(a) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses:
(1) Are reimbursable under Title XVIII of the Social Security Act; or
(2) Would be reimbursable but for the application of a deductible or coinsurance amount.
(b) The requirements of this subdivision (5)(A)(ii) do not apply to expenses that are reimbursable under Title XVIII of the Social Sec
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-97-304
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 23-97-304. This identifies an authority to review, not proof of applicability.