58-17-97Provisions covering preexisting conditions.

Any accident and sickness policy or certificate subject to the provisions of this chapter, other than credit health insurance as defined in subdivision 58-19-2(1) and a health benefit plan as defined in § 58-17-66, shall comply with the following provisions:

(1)    No policy or certificate may deny, exclude, or limit benefits for a covered individual for claims incurred more than twelve months following the effective date of the person's coverage due to a preexisting condition;

(2)    No policy or certificate may define a preexisting condition more restrictively than:

(a)    A condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve months immediately preceding the effective date of coverage;

(b)    A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve months immediately preceding the effective date of coverage; or

(c)    A pregnancy existing on the effective date of coverage.

Source: SL 1997, ch 288, § 2; SL 2001, ch 275, § 4; SL 2013, ch 248, § 1.