58-17-97.   Provisions covering preexisting conditions. Any accident and sickness policy or certificate subject to the provisions of this chapter, other than a health benefit plan as defined in § 58-17-66, shall comply with the following provisions:

             (1)      No policy or certificate may deny, exclude, or limit benefits for a covered individual for claims incurred more than twelve months following the effective date of the person's coverage due to a preexisting condition;

             (2)      No policy or certificate may define a preexisting condition more restrictively than:

             (a)      A condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve months immediately preceding the effective date of coverage;

             (b)      A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve months immediately preceding the effective date of coverage; or

             (c)      A pregnancy existing on the effective date of coverage.

Source: SL 1997, ch 288, § 2; SL 2001, ch 275, § 4.

---