Employers have no obligation under Texas 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 may exclude coverage for:
• Preexisting conditions or diseases;
• Mental or nervous disorders (but not for Alzheimer's disease or related disorders or biologically based brain diseases/serious mental illness, including schizophrenia, paranoid and other psychotic disorders, bipolar disorders, major depressive disorders, and schizo-affective disorders);
• Alcoholism and drug addiction;
• Illnesses, treatments, or medical conditions arising out of any of the following: 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 intentionally self-inflicted injury; or aviation activity as a non-fare-paying passenger;
• Treatment provided in a governmental facility (unless otherwise required by law);
• Benefits provided under Medicare or other governmental program (except Medicaid); any state or federal workers' compensation, employer's liability, or occupational disease law; or any motor vehicle no-fault law;
• Services performed by a member of the covered person's immediate family;
• Services for which no charge is normally made in the absence of insurance; or
• Expenses for services or items available or paid under another long-term care insurance or health insurance policy (28 TAC Sec. 3.3826).
Preexisting condition limitations in long-term care insurance policies may not ...