Employers have no obligation under Pennsylvania 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.
A long-term care insurance policy may not limit or exclude coverage by type of illness, treatment, medical condition, or accident, except for:
• Preexisting conditions and diseases;
• Mental or nervous disorders (but not Alzheimer's disease or related degenerative or demential illnesses);
• 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 as a non-fare-paying passenger;
• Treatment provided in a government facility (unless a charge is made and the insured is legally obligated to pay);
• Services for which benefits are available under Medicare or other governmental program (except Medicaid); or any state or federal workers' compensation, employer's liability, or occupational disease law;
• Services provided by a member of the covered person's immediate family;
• Services for which no charge is normally made in the absence of insurance;
• Expenses for services or items available or paid under another long-term care insurance or health insurance policy; and
• In the case of a qualified long-term care insurance contract, expenses for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act or would be reimbursable ...