If a group long-term care policy is replaced by another policy to the same master policyholder issued, the replacing insurer shall do all of the following:
(a) Provide benefits identical to the terminating coverage or benefits determined by the commissioner to be at least substantially equivalent to the terminating coverage. Lesser or greater benefits may be provided if the commissioner determines the replacement coverage is the most advantageous choice for the beneficiaries.
(b) Calculate the premium on the insured’s age at the time of issue of the group certificate for the coverage which is being replaced. If the coverage being replaced has itself replaced previous group coverage, the premium for the newest replacement coverage shall be calculated on the insured’s age at the time the previous group certificate was issued. If the replacement coverage adds new or increased benefits, the premium for the new or increased benefits may be calculated on the insured’s age at the time of replacement.
(c) Offer coverage to all persons covered under the replaced group policy on its date of termination.
(d) Not exclude coverage for preexisting conditions if the terminating group coverage would provide benefits for those preexisting conditions.
(e) Not require new waiting periods, elimination periods, probationary periods, or similar preconditions related to preexisting conditions. The insurer shall waive any such time periods applicable to preexisting conditions to the extent that similar preconditions have been satisfied under the terminating group coverage.
(f) Not vary the benefits or the premium based on the insured’s health, disability status, claims experience, or use of long-term care services.
(Added by Stats. 1992, Ch. 1132, Sec. 36. Effective January 1, 1993.)
Last modified: October 25, 2018