Employers have no obligation under Ohio 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 "preexisting condition" may not be defined more restrictively than as a condition for which medical advice or treatment was recommended by, or received from, a provider of healthcare services within six months preceding the effective date of coverage of an insured person. Long-term care insurance policies may not exclude coverage for a loss or confinement that is a result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person (OH Code Sec. 3923.44).
A long-term care insurance policy may not:
• Condition eligibility for any institutional benefits on prior hospitalization;
• Condition eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
• Condition eligibility for any institutional benefits, other than waiver of premium or post-confinement, post-acute care, or recuperative benefits, on a requirement of prior institutionalization.
A long-term care insurance policy that conditions eligibility for noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days. The policy must provide that eligibility for noninstitutional benefits may be established by the alternative of a hospitalization period of no more than three days.
A long-term care insurance policy that provides benefits only following ...