§431:10H-203  Limitations andexclusions.  (a)  A policy may not bedelivered or issued for delivery in this State as long-term care insurance ifthe policy limits or excludes coverage by type of illness, treatment, medicalcondition, or accident, except as follows:

(1)  Preexisting conditions or diseases;

(2)  Mental or nervous disorders; however, this shallnot permit exclusion or limitation of benefits on the basis of Alzheimer'sdisease;

(3)  Alcoholism and drug addiction;

(4)  Illness, treatment, or medical condition arisingout of:

(A)  War or act of war, whether declared orundeclared;

(B)  Participation in a felony, riot, orinsurrection;

(C)  Service in the armed forces or unitsauxiliary thereto;

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

(E)  Aviation (this exclusion applies only tonon-fare-paying passengers);

(5)  Treatment provided in a government facility(unless required by law), services for which benefits are available undermedicare or other governmental program (except medicaid), any state or federalworkers' compensation, employer's liability, or occupational disease law, orany motor vehicle insurance law, services provided by a member of the coveredperson's immediate family, and services for which no charge is normally made inthe absence of insurance;

(6)  Expenses for services or items available or paidunder another long-term care insurance or health insurance policy; or

(7)  In the case of a qualified long-term careinsurance contract, expenses for services or items to the extent that theexpenses are reimbursable under Title XVIII of the Social Security Act or wouldbe so reimbursable but for the application of a deductible or coinsuranceamount.

(b)  This section is not intended to prohibitexclusions and limitations by type of provider.  However, no long-term careissuer may deny a claim because services are provided in a state other than thestate of policy issue under the following conditions:

(1)  When the state other than the state of policyissue does not have the provider licensing, certification, or registrationrequired in the policy, but where the provider satisfies the policyrequirements outlined for providers in lieu of licensure, certification,registration; or

(2)  When the state other than the state of policyissue licenses, certifies, or registers the provider under another name.

For purposes of this subsection, "state ofpolicy issue" means the state in which the individual policy orcertificate was originally issued.

(c)  This section is not intended to prohibitterritorial limitations. [L 1999, c 93, pt of §2; am L 2007, c 233, §12]