GENERAL ASSEMBLY OF NORTH CAROLINA
1989 SESSION

CHAPTER 207
SENATE BILL 503

AN ACT TO IMPROVE COVERAGE UNDER LONG-TERM CARE INSURANCE.

The General Assembly of North Carolina enacts:

Section 1.  G.S. 58-545(b) is amended by adding a new subdivision to read:
"(3)	Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care."
Sec. 2.  G.S. 58-545(c) reads as rewritten:
"(c)	Pre-existing condition:
(1)	No long-term care insurance policy, other than that issued to a group defined in G.S. 58-543(3)a., shall use a definition of 'pre-existing condition' that is more restrictive than the following:  'pre-existing condition' means 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.
(2)	No long-term care insurance policy , other than that issued to a group defined in G.S. 58-543(3)a., shall exclude coverage for a loss or confinement that is the result of a pre-existing condition unless such loss or confinement begins 
		within six months following the effective date of coverage of an insured person."
Sec. 3.  G.S. 58-545(d) reads as rewritten:
)	"(d)	Effective October 1, 1989, no long-term care insurance policy may be delivered or issued for delivery in this State if it:
(1)	Conditions eligibility for any benefits on a prior hospitalization requirement; or
(2)	Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care.
(d1)	Effective October 1, 1989, any long-term care insurance policy containing any limitations or conditions for eligibility other than those prohibited by law shall describe in a separate paragraph of the policy, to be entitled 'Limitations or Conditions on Eligibility for Benefits', the limitations or conditions, including any required number of days of confinement.
(d2)	A long-term care insurance policy that contains a benefit advertised, marketed, or offered as home health care or a home care benefit may not condition receipt of benefits on a prior institutionalization requirement.
(d3)	A long-term care insurance policy that conditions eligibility for non-institutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than 30 days for which benefits are paid."
Sec. 4.  G.S. 58-545(f) reads as rewritten:
"(f)	An individual long-term care insurance policyholder has the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Individual long-term care insurance policies shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that unless the policyholder has received benefits under the policy, the policyholder has the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason."
Sec. 5.  G.S. 58-546(a)(11) reads as rewritten:
"(11)	'Intermediate care facility' shall be defined in accordance with the terms of G.S. 131E-176(14b)."
Sec. 6.  G.S. 58-546 is amended by adding a new subsection to read:
"(c)	All long-term care insurance policies must be filed with and approved by the Commissioner before they can be used in this State and are subject to the provisions of Article 33 of this Chapter."
Sec. 7.  This act applies to all new and renewal long-term care insurance policies, as defined in G.S. 58-543(4) and (5), that are delivered or issued for delivery in this State on and after the effective date of this act.
Sec. 8.  This act shall become effective October 1, 1989.
In the General Assembly read three times and ratified this the 5th day of June, 1989.