Provisions 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.