HEARING - U.S. Senate Special Committee on Aging
HEARING - U.S. Senate Special Committee on Aging HEARING - U.S. Senate Special Committee on Aging
Itiem ' A;Vlicahility nd 167 Except as otherwise specifically provided, this regulation applies to all long-term care insurance policies delivered or issued for delivery in this mate on or after the effective date hereof, by insurers, fraternal benefit societies, nonprofit health, hospital and medical service corporations, prepaid health plans, health maintenance organizations and all similar organizations. Drafting Note: The regulation, like the Model Act, is intended to apply to policies, contracts, subscriber agreements. riders and endorsements whether issued by insurers, fraternal benefit societies nonprofit health, hospitaL and medical service corporations, prepaid health plans, health maintenance organizations and all similar organizations. In order to include such organizations, regulations should identify them in accordance with statutory terminology or by specific statutory citation. Depending upon state law and regulation, insurance departnent jurisdiction, and other factors, separate regulations may be required. In any event, the regulation should provide that the particular terminology used by these Plans, organizations and arrangements (e.g, contract policy- certificate subscriber, member,) may be substituted for, or added to, the corresponding terms used in this regulation. Section 4- fkfiiitifrw For the purpose of this regulation, the terms long-term care insurance, group long-term care insurance, commissioner, applicant, policy and certificate shall have the meanings set forth in Section 3 of the NAIC Long-Term Care Insurance Model Act. Drafting Notw Where the word "Commissioner" appears in this regulation. the appropriate designation for the chief insurance supervisory official of the state should be substituted. To extent that the model act is not adopted, the full definition of the above terms contained in that model act should be incorporated in this section.
Setinzn IS. Poicyx D~efinitieno aid Tern 168 No policy may be advertised, solicited or issued for delivery in this state as long-term care insurance unless the definitions of terms set forth below, if used in the policy, conform to the requirements of this section. As 'Medicare" shall be defined as "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended," or "Title 1, Part I of Public Laws 89-97. as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act." as then constituted and any later amendments or substitutes thereof" or words of similar import. B. 'Mental or Nervous Disorder" shall not be defined more restrictively than a definition including neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder. C -Skilled Nursing Care", 'Intermediate Care", Personal Care", 'Home Care", and other services shall be defined in relation to the level of skill required, the nature of the care, and the setting where care must be delivered. a1 "Skilled Nursing Facility", "Extended Care Facility", Intermediate Care Facility", "Convalescent Nursing Home", "Personal Care Facility", "Home Care Agency", and other providers of services shall be defined in relation to the services and facilities required to be available and the licensure or degree status of those providing or supervising the services. The definition may require that the facility be appropriately licensed or certified.
- Page 119 and 120: Consunmer Unon Pubtishcr of Consume
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- Page 167 and 168: 164 -13- E. Affordability of Long T
- Page 169: NAIC LTC ADVISORY COMMITEE EXPOSURE
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- Page 177 and 178: artinM B Requirmnts for Rplnmacwt 1
- Page 179 and 180: 176 The above "Notice to Applicant"
- Page 181 and 182: (pinnal Rasting &mdsninn 178 Benefi
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- Page 185 and 186: COMPAIeSON OF LOtG TEIM CoAt PfLtCI
- Page 187 and 188: COMPABI:SZN OF LC#C TE" CAiE -OLICI
- Page 189 and 190: COWaPAISON Of LOSt TERM CARE POLICI
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- Page 193 and 194: COGPARISON OF LONG TERM CARE POLICI
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Setinzn IS. Poicyx D~efinitieno aid Tern<br />
168<br />
No policy may be advertised, solicited or issued for delivery in this state as<br />
l<strong>on</strong>g-term care insurance unless the definiti<strong>on</strong>s of terms set forth below, if<br />
used in the policy, c<strong>on</strong>form to the requirements of this secti<strong>on</strong>.<br />
As 'Medicare" shall be defined as "The Health Insurance for the Aged Act,<br />
Title XVIII of the Social Security Amendments of 1965 as Then C<strong>on</strong>stituted<br />
or Later Amended," or "Title 1, Part I of Public Laws 89-97. as Enacted by<br />
the Eighty-Ninth C<strong>on</strong>gress of the United States of America and popularly<br />
known as the Health Insurance for the Aged Act." as then c<strong>on</strong>stituted and<br />
any later amendments or substitutes thereof" or words of similar import.<br />
B. 'Mental or Nervous Disorder" shall not be defined more restrictively than<br />
a definiti<strong>on</strong> including neurosis, psych<strong>on</strong>eurosis, psychopathy, psychosis,<br />
or mental or emoti<strong>on</strong>al disease or disorder.<br />
C -Skilled Nursing Care", 'Intermediate Care", Pers<strong>on</strong>al Care", 'Home Care",<br />
and other services shall be defined in relati<strong>on</strong> to the level of skill<br />
required, the nature of the care, and the setting where care must be<br />
delivered.<br />
a1 "Skilled Nursing Facility", "Extended Care Facility", Intermediate Care<br />
Facility", "C<strong>on</strong>valescent Nursing Home", "Pers<strong>on</strong>al Care Facility", "Home<br />
Care Agency", and other providers of services shall be defined in relati<strong>on</strong><br />
to the services and facilities required to be available and the licensure<br />
or degree status of those providing or supervising the services. The<br />
definiti<strong>on</strong> may require that the facility be appropriately licensed or<br />
certified.
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