Ariz. Admin. Code § R20-6-1021 - Additional Standards for Benefit Triggers for Qualified Long-term Care Insurance Contracts
A. A
qualified long-term care insurance contract shall pay only for qualified
long-term care services received by a chronically ill individual provided under
a plan of care prescribed by a licensed health care practitioner, which is not
subject to approval or modification by the insurer.
B. A qualified long-term care insurance
contract shall condition the payment of benefits on a certified determination
of the insured's inability to perform activities of daily living for an
expected period of at least 90 days due to a loss of functional capacity or to
severe cognitive impairment.
C.
Licensed health care practitioners shall perform the certified determinations
regarding activities of daily living and cognitive impairment required under
subsection (B).
D. Certified
determinations required under subsection (B) may be performed at the direction
of the carrier as is reasonably necessary with respect to a specific claim,
except that when a licensed health care practitioner has certified that an
insured is unable to perform activities of daily living for an expected period
of at least 90 days due to a loss of functional capacity and the insured is in
claim status, the certified determination may not be rescinded and additional
certified determinations may not be performed until after the expiration of the
90-day period.
Notes
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