Employers have no obligation under North Carolina law to offer long-term care insurance to their employees. However, if long-term care insurance is among the benefits offered, certain state law requirements limit how the plan may be designed.
Long-term care insurance policies generally may not limit or exclude coverage by type of illness, treatment, medical condition, or accident, except for the following:
• Certain preexisting conditions;
• Mental or nervous disorders, except for Alzheimer's disease;
• Alcoholism and drug addiction;
• Illness, treatment, or medical condition arising out of war or act of war (whether declared or undeclared); participation in a felony, riot, or insurrection; service in the armed forces or auxiliary units; suicide, attempted suicide, or an intentional self-inflicted injury; or aviation activity as a non-fare-paying passenger;
• Treatment provided in a government facility (unless otherwise required by law);
• Services for which benefits are available under Medicare (unless otherwise required by law), under any other governmental program (except Medicaid), or under any state or federal workers' compensation, employer's liability, or occupational disease law;
• Services provided by a member of the insured's immediate family;
• Services for which no charge is normally made in the absence of insurance;
• Exclusions and limitations for payment for services provided outside the United States; and
• Legitimate variations in benefit levels to reflect differences in provider rates (11 NCAC 12.1004).
Preexisting condition limitations in long-term care insurance policies may not exclude coverage for more than six months after the effective ...