431:10-109

Disclosure of health care coverage and benefits

[§431:10H-109] Prior hospitalization; prior institutionalization. (a) No long-term care insurance policy may be delivered or issued for delivery in this State if the policy:

(1) Conditions eligibility for any benefits on a prior hospitalization requirement;

(2) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or

(3) Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization requirement.

(b) A long-term care insurance policy containing post-confinement, post-acute care, or recuperative benefits shall clearly label, in a separate paragraph of the policy or certificate, entitled “Limitations or Conditions on Eligibility for Benefits”, such limitations or conditions including any required number of days of confinement.

© A long-term care insurance policy that conditions eligibility of non-institutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty days. [L 1999, c 93, pt of §2] the period shown on the identification card have not been paid in full, bring a civil action for three times the unpaid portion of the premiums. Notwithstanding section 607-14, the insurer shall be awarded reasonable attorney’s fees and court costs. If the motor vehicle insurance identification card is returned after the civil action is filed but before the matter is taken to trial, the insurer shall be awarded damages of not less than $100, but not more than the amount of the unpaid premiums together with reasonable attorney’s fees and costs as provided in this section.

(d) Notwithstanding the provisions of this section, the imposition of criminal sanctions under section 431:10C-117 shall not be precluded. [L 1987, c 347, pt of §2; am L 1989, c 195, §32; am L 1997, c 251, §20; am L 2005, c 22, §26]