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Statutes Text

Article - Insurance




§15–1A–05.

    (a)    This section applies to all grandfathered plans except grandfathered plans that are individual plans and to every health benefit plan that is not a grandfathered plan.

    (b)    A carrier may not:

        (1)    exclude or limit benefits because a health condition was present before the effective date of coverage; or

        (2)    deny coverage because a health condition was present before or on the date of denial.

    (c)    The prohibition in subsection (b) of this section applies whether or not:

        (1)    any medical advice, diagnosis, care, or treatment was recommended or received for the condition; or

        (2)    the health condition was identified as a result of:

            (i)    a pre–enrollment questionnaire or physical examination given to an individual; or

            (ii)    a review of records relating to the pre–enrollment period.



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