No policy may be delivered or issued for delivery in this state as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident, except as to the following:
(a) Preexisting conditions or diseases.
(b) Alcoholism and drug addiction.
(c) Illness, treatment, or a medical condition arising out of any of the following:
(1) War or act of war, whether declared or undeclared.
(2) Participation in a felony, riot, or insurrection.
(3) Service in the Armed Forces or units auxiliary thereto.
(4) Suicide, whether or not the person had mental capacity to control what he or she was doing, attempted suicide, or intentionally self-inflicted injury.
(5) Aviation in the capacity of a non-fare-paying passenger.
(d) Treatment provided in a government facility, unless otherwise required by law, services for which benefits are available under Medicare or other governmental programs (except Medi-Cal or medicaid), state or federal workers’ compensation, employer’s liability or occupational disease law, or a motor vehicle no fault law, services provided by a member of the covered person’s immediate family, and services for which no charge is normally made in the absence of insurance.
(e) This section does not prohibit exclusions and limitations by type of provider or territorial limitations.
(Amended by Stats. 2014, Ch. 144, Sec. 45. (AB 1847) Effective January 1, 2015.)
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