760 Ind. Admin. Code 2-3-2

Current through October 31, 2024

Section 760 IAC 2-3-2 - Exclusions

Authority: IC 27-8-12-7

Affected: IC 27-8-12

Sec. 2.

A policy, certificate, or subscriber agreement may not be delivered or issued for delivery in Indiana as long term care insurance if the policy, certificate, or subscriber agreement limits or excludes coverage by type of illness, treatment, medical condition, or accident, except as follows:

(1) Preexisting conditions or diseases.

(2) Mental or nervous disorders; however, this shall not permit exclusion or limitation of benefits on the basis of Alzheimer's disease or related degenerative and dementing illnesses.

(3) Alcoholism and drug addiction.

(4) Illness, treatment, or medical condition arising out of:

(A) war or act of war (whether declared or undeclared);

(B) participation in a felony, riot, or insurrection;

(C) service in the armed forces or units auxiliary thereto;

(D) suicide (sane or insane), attempted suicide, or intentionally self-inflicted injury; or

(E) aviation (this exclusion applies only to nonfare paying passengers).

(5) Treatment provided in a government facility unless otherwise required by law as follows:

(A) Services for which benefits are available under any of the following:

(i) Medicare or other governmental program (except Medicaid).

(ii) Any state or federal workers' compensation.

(iii) Employer's liability or occupational disease law.

(iv) Any motor vehicle no-fault law.

(B) Services provided by a member of the covered person's immediate family.

(C) Services for which no charge is normally made in the absence of insurance.

(6) Expenses for services or items available or paid under another long term care insurance or health insurance policy.

(7) In the case of a federally tax-qualified long term care insurance contract, expenses for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act or would be reimbursable but for the application of a deductible or coinsurance amount.

This section is not intended to prohibit exclusions and limitations by type of provider or territorial limitations.

760 IAC 2-3-2

Department of Insurance; 760 IAC 2-3-2; filed Oct 30, 1992, 12:00 p.m.: 16 IR 858; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; filed Oct 7, 2004, 1:00 p.m.: 28 IR 565; readopted filed Nov 27, 2007, 4:01 p.m.: 20071226-IR-760070717RFA; readopted filed November 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFA

Readopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFA

Readopted filed 11/30/2022, 11:39 a.m.: 20221228-IR-760220302RFA