Short answer: In Texas, an LTC plan cannot deny a claim for a preexisting condition for losses more than 6 months after coverage starts, must give a 30-day free look with a full refund, and cannot use or raise premium rates without approval from the Texas Department of Insurance. These apply to group certificates as well as individual policies.
Preexisting conditions. A Texas long-term care benefit plan may not deny coverage for losses incurred more than 6 months after coverage starts because of a preexisting condition, and may not define one more broadly than a condition for which medical advice or treatment was given or recommended within 6 months before coverage began.
Free look. The policy or group certificate must say that an applicant who is not satisfied can return it within 30 days of delivery for a full premium refund.
Rates. Rates must be filed with and approved by the Texas Department of Insurance, and an approved increase requires at least 45 days’ notice. Federal tax-qualified status also requires that the insurer offer inflation protection and a nonforfeiture benefit.
For an employer, LTC provided under a separate policy is a limited excepted benefit, so it sits outside the group health plan market reform rules that apply to the medical plan.