Under which circumstance are pre-existing condition clauses in a long-term care policy waived?

Pre-existing condition clauses in a long-term care policy are waived when the new policy replaces existing coverage with the same insurer. This provision is designed to provide a seamless transition for policyholders who are switching their coverage without risking denial of benefits based on conditions that existed prior to the start of the new policy. By maintaining coverage with the same insurer, the policyholder's medical underwriting history is recognized, allowing them to avoid penalties or exclusions that could arise from any pre-existing conditions that may have been present prior to the new policy's effective date.

In contrast, switching to a different insurer typically means that the new insurer will base its underwriting decisions on its own criteria, which could include a full assessment of any pre-existing conditions. Similarly, being over the age of 65 or transferring coverage to a family member does not automatically remove pre-existing condition clauses and would likely require separate consideration based on the terms of the new policy or the insurer’s guidelines.