core standards for individual long term care insurance policies

Date: 7/13/10
Under review by the Product Standards Committee
Higlighted changes are those added since the 7/6 draft.
appropriate licensing agency. A nursing facility may be a freestanding facility, including the
following:
(i)
Nursing facility;
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(ii)
(iii)
(iv)
(v)
Skilled nursing home;
Intermediate nursing care home;
Assisted living facility; or
Residential health care facility.
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(o)
(p)
(q)
(r)
(s)
“Personal care” means the provision of hands-on services to assist an individual with activities of
daily living.
“Qualified long-term care services” means services that meet the requirements of § 7702(c)(1) of the
Internal Revenue Code of 1986, as amended, as follows: necessary diagnostic, preventive, therapeutic,
curative, treatment, mitigation and rehabilitative services, and maintenance or personal care services
which are required by a chronically ill individual, and are provided pursuant to a plan of care
prescribed by a licensed health care practitioner.
“Skilled nursing care,” “personal care,” “home care,” “specialized care,” “assisted living care” and
other services shall be defined in relation to the level of skill required, the nature of the care and the
setting in which care shall be delivered.
“Toileting” means getting to and from the toilet, getting on and off the toilet, and performing
associated personal hygiene.
“Transferring” means moving into or out of a bed, chair or wheelchair.
(2) All providers of services, including but not limited to “adult day care,” “skilled nursing facility,” “extended
care facility,” “convalescent nursing home,” “personal care facility,” “specialized care providers,” “assisted
living,” and “home care agency” shall be defined in relation to the services and facilities required to be
available and the licensure, certification, registration or degree status of those providing or supervising the
services in the state where the policy was issued. When the definition requires that the provider be
appropriately licensed, certified or registered, it shall also state what requirements a provider shall meet in
lieu of licensure, certification or registration when the state in which the service is to be furnished does not
require a provider of such services to be licensed, certified or registered, or if the state licenses, certifies or
registers the provider of services under another name.
Deleted: t
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J. DEPENDENT AND FAMILY MEMBER COVERAGE
(1) The policy may provide coverage for dependents and family members. If the policy provides such
coverage:
(a)
(b)
The policy shall comply with the applicable state law where the policy is delivered or issued for
delivery, with respect to the coverage and benefits available to a person who is in a legallysanctioned
domestic partnership or civil union and to their families, or available to a person who is
in a legally-sanctioned marriage with the insured and to their families; and
Nothing in this provision shall be construed as requiring a company to provide coverage or
benefits to any person who is in a domestic partnership, civil union, or marriage or to their
families in a state where such relationships are not legally recognized.
© IIPRC 2010 12