§5051-A. Required and prohibited provisions
1.
Prohibited provisions.
A long-term care policy may not:
A.
Contain coverage for skilled nursing facilities only;
[PL 1989, c. 556, Pt. B, §3 (NEW).]
B.
Exclude coverage for skilled, intermediate or custodial care received by a resident of a skilled nursing or intermediate care facility;
[PL 1989, c. 556, Pt. B, §3 (NEW).]
C.
Require a prior hospital stay as a condition for any policy benefits;
[PL 1989, c. 556, Pt. B, §3 (NEW).]
D.
Require a prior skilled nursing facility stay as a condition for intermediate care facility benefits; or
[PL 1989, c. 556, Pt. B, §3 (NEW).]
E.
Require prior institutionalization as a condition of receipt of home health care benefits.
[PL 1989, c. 556, Pt. B, §3 (NEW).]
[PL 1989, c. 556, Pt. B, §3 (NEW).]
2.
Required provisions.
A long-term care policy must provide:
A.
Custodial care benefits that are at least 50% of those provided for skilled nursing care in a nursing facility provided that the benefits need not exceed usual, customary and reasonable charges;
[PL 1989, c. 556, Pt. B, §3 (NEW).]
B.
Benefits for home health care services rendered by a home health care provider;
[PL 1989, c. 556, Pt. B, §3 (NEW).]
C.
Home health care coverage for at least 90 visits in any continuous 12-month period during which coverage is in force; and
[PL 1989, c. 556, Pt. B, §3 (NEW).]
D.
Per visit benefits for home health care services which are at least 50% of the daily benefit for skilled nursing facility confinement provided that the benefit need not exceed usual, customary and reasonable charges.
[PL 1989, c. 556, Pt. B, §3 (NEW).]
[PL 1989, c. 556, Pt. B, §3 (NEW).]
SECTION HISTORY
PL 1989, c. 556, §B3 (NEW).