{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-5204.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-5204.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-5204.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-5204.html"}],"law_id":78536,"edition_id":1,"section_id":78536,"structure_id":15692,"section_number":"38.2-5204","catch_line":"Preexisting conditions","history":"1987, c. 586; 1990, c. 285.","full_text":"A\n\nNo long-term care insurance policy or certificate shall use a definition of “preexisting condition” which is more restrictive than the following: “preexisting condition” means the existence of symptoms which would cause an ordinary prudent person to seek diagnosis, care or treatment, or a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person.B\n\nNo long-term care insurance policy may exclude coverage for a loss or confinement which is the result of a preexisting condition for a period of confinement longer than six months following the effective date of coverage of an insured person.C\n\nThe Commission may extend the limitation periods set forth in subsections A and B of this section as to specific age group categories or specific policy forms upon findings that the extension is in the best interest of the public.D\n\nThe definition of “preexisting condition” does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, underwriting in accordance with that insurer’s established underwriting standards for long-term care insurance policies. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subsection A or B expires. No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subsection A or B.","order_by":null,"text":{"0":{"id":281446,"text":"No long-term care insurance policy or certificate shall use a definition of “preexisting condition” which is more restrictive than the following: “preexisting condition” means the existence of symptoms which would cause an ordinary prudent person to seek diagnosis, care or treatment, or a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":281447,"text":"No long-term care insurance policy may exclude coverage for a loss or confinement which is the result of a preexisting condition for a period of confinement longer than six months following the effective date of coverage of an insured person.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":281448,"text":"The Commission may extend the limitation periods set forth in subsections A and B of this section as to specific age group categories or specific policy forms upon findings that the extension is in the best interest of the public.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":281449,"text":"The definition of “preexisting condition” does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, underwriting in accordance with that insurer’s established underwriting standards for long-term care insurance policies. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subsection A or B expires. No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subsection A or B.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":15692,"edition_id":1,"name":"Long-Term Care Insurance","identifier":"52","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:57:59","date_modified":"2026-06-26 03:57:59","permalink":{"id":217773,"object_type":"structure","relational_id":15692,"identifier":"52","token":"38.2\/52","url":"\/38.2\/52\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":81666,"structure_id":15692,"section_number":"38.2-5200","catch_line":"Definitions","url":"\/38.2-5200\/","token":"38.2\/52\/38.2-5200","metadata":false},{"id":69288,"structure_id":15692,"section_number":"38.2-5201","catch_line":"What laws applicable","url":"\/38.2-5201\/","token":"38.2\/52\/38.2-5201","metadata":false},{"id":60910,"structure_id":15692,"section_number":"38.2-5202","catch_line":"Promulgation of regulations; standards for policy provisions","url":"\/38.2-5202\/","token":"38.2\/52\/38.2-5202","metadata":false},{"id":81626,"structure_id":15692,"section_number":"38.2-5202.1","catch_line":"Refund of premium for cancellation or termination of policy","url":"\/38.2-5202.1\/","token":"38.2\/52\/38.2-5202.1","metadata":false},{"id":63690,"structure_id":15692,"section_number":"38.2-5203","catch_line":"Prohibited provisions","url":"\/38.2-5203\/","token":"38.2\/52\/38.2-5203","metadata":false},{"id":78536,"structure_id":15692,"section_number":"38.2-5204","catch_line":"Preexisting conditions","url":"\/38.2-5204\/","token":"38.2\/52\/38.2-5204","metadata":false},{"id":72116,"structure_id":15692,"section_number":"38.2-5205","catch_line":"Prior institutionalization","url":"\/38.2-5205\/","token":"38.2\/52\/38.2-5205","metadata":false},{"id":60114,"structure_id":15692,"section_number":"38.2-5206","catch_line":"Rates","url":"\/38.2-5206\/","token":"38.2\/52\/38.2-5206","metadata":false},{"id":61118,"structure_id":15692,"section_number":"38.2-5206.1","catch_line":"Rate increases; notice requirements","url":"\/38.2-5206.1\/","token":"38.2\/52\/38.2-5206.1","metadata":false},{"id":78975,"structure_id":15692,"section_number":"38.2-5207","catch_line":"Disclosure","url":"\/38.2-5207\/","token":"38.2\/52\/38.2-5207","metadata":false},{"id":86980,"structure_id":15692,"section_number":"38.2-5207.1","catch_line":"Disclosure; life insurance policies","url":"\/38.2-5207.1\/","token":"38.2\/52\/38.2-5207.1","metadata":false},{"id":66370,"structure_id":15692,"section_number":"38.2-5207.2","catch_line":"Long-term care benefits; monthly report","url":"\/38.2-5207.2\/","token":"38.2\/52\/38.2-5207.2","metadata":false},{"id":61536,"structure_id":15692,"section_number":"38.2-5208","catch_line":"Right to return; free look provision","url":"\/38.2-5208\/","token":"38.2\/52\/38.2-5208","metadata":false},{"id":65391,"structure_id":15692,"section_number":"38.2-5209","catch_line":"Incontestability","url":"\/38.2-5209\/","token":"38.2\/52\/38.2-5209","metadata":false},{"id":74733,"structure_id":15692,"section_number":"38.2-5210","catch_line":"Nonforfeiture benefit","url":"\/38.2-5210\/","token":"38.2\/52\/38.2-5210","metadata":false}],"previous_section":{"id":63690,"structure_id":15692,"section_number":"38.2-5203","catch_line":"Prohibited provisions","url":"\/38.2-5203\/","token":"38.2\/52\/38.2-5203","metadata":false},"next_section":{"id":72116,"structure_id":15692,"section_number":"38.2-5205","catch_line":"Prior institutionalization","url":"\/38.2-5205\/","token":"38.2\/52\/38.2-5205","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-5204\/","history_text":"

This law was first created in 1987. The record of its establishment is cataloged in chapter 586 of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. Unfortunately, the 1987 \u201cActs\u201d aren\u2019t available online. It has been modified 1 time. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. That modification is as follows: in 1990, chapter 285.<\/p>","references":false,"refers_to":false,"permalink":{"id":217795,"object_type":"law","relational_id":78536,"identifier":"38.2-5204","token":"38.2\/52\/38.2-5204","url":"\/38.2-5204\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-5204\/","token":"38.2\/52\/38.2-5204","dublin_core":{"Title":"Preexisting conditions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-5204","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No long-term care insurance<\/span> policy<\/span> or certificate<\/span> shall use a definition of “preexisting condition<\/span>” which is more restrictive than the following: “preexisting condition<\/span>” means the existence of symptoms which would cause an ordinary prudent person<\/span> to seek diagnosis, care or treatment, or a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No long-term care insurance<\/span> policy<\/span> may exclude coverage for a loss or confinement which is the result of a preexisting condition<\/span> for a period of confinement longer than six months following the effective date of coverage of an insured person<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The Commission<\/span> may extend the limitation periods set forth in subsections A and B of this section as to specific age group categories or specific policy<\/span> forms upon findings<\/span> that the extension is in the best interest of the public. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The definition of “preexisting condition<\/span>” does not prohibit an insurer<\/span> from using an application form designed to elicit the complete health history of an applicant<\/span>, and, on the basis of the answers on that application, underwriting in accordance with that insurer<\/span>’s established underwriting standards for long-term care insurance<\/span> policies. Unless otherwise provided in the policy<\/span> or certificate<\/span>, a preexisting condition<\/span>, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subsection A or B expires. No long-term care insurance<\/span> policy<\/span> or certificate<\/span> may exclude or use waivers<\/span> or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subsection A or B. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPREEXISTING CONDITIONS (\u00a7 38.2-5204)\n\nA. No long-term care insurance policy or certificate shall use a definition of\n“preexisting condition” which is more restrictive than the\nfollowing: “preexisting condition” means the existence of symptoms\nwhich would cause an ordinary prudent person to seek diagnosis, care or\ntreatment, or a condition for which medical advice or treatment was recommended\nby, or received from a provider of health care services, within six months\npreceding the effective date of coverage of an insured person.\n\nB. No long-term care insurance policy may exclude coverage for a loss or\nconfinement which is the result of a preexisting condition for a period of\nconfinement longer than six months following the effective date of coverage of\nan insured person.\n\nC. The Commission may extend the limitation periods set forth in subsections A\nand B of this section as to specific age group categories or specific policy\nforms upon findings that the extension is in the best interest of the public.\n\nD. The definition of “preexisting condition” does not prohibit an\ninsurer from using an application form designed to elicit the complete health\nhistory of an applicant, and, on the basis of the answers on that application,\nunderwriting in accordance with that insurer’s established underwriting\nstandards for long-term care insurance policies. Unless otherwise provided in\nthe policy or certificate, a preexisting condition, regardless of whether it is\ndisclosed on the application, need not be covered until the waiting period\ndescribed in subsection A or B expires. No long-term care insurance policy or\ncertificate may exclude or use waivers or riders of any kind to exclude, limit,\nor reduce coverage or benefits for specifically named or described preexisting\ndiseases or physical conditions beyond the waiting period described in\nsubsection A or B.\n\nHISTORY: 1987, c. 586; 1990, c. 285.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}