Employers have no obligation under New Jersey law to offer long-term care (LTC) insurance to their employees. However, if LTC insurance is among the benefits offered, certain state law requirements limit how the plan may be designed.
A “preexisting condition” cannot be defined more restrictively than as a condition for which medical advice or treatment was recommended by, or received from, a healthcare services provider within 6 months preceding the effective date of coverage of an insured person (N.J.A.C. Sec. 11:4-34.3). A long-term care insurance policy cannot exclude coverage for a loss or confinement that is the result of a preexisting condition if the loss or confinement begins later than 6 months following the effective date of coverage of an insured person (N.J.A.C. Sec. 11:4-34.4).
Generally, group LTC insurance issued in New Jersey must provide covered individuals with a basis for continuation or conversion of coverage (N.J.A.C. Sec. 11:4-34.4).
There are additional requirements for LTC insurance policies. For example:
• If a policy contains a “preexisting condition” limitation, this provision must appear as a separate paragraph within the policy and be labeled as “Preexisting Condition Limitations"; and
• All policies must be guaranteed renewable (but the same premium is not guaranteed) (N.J.A.C. Sec. 11:4-34.6).