Fla. Admin. Code Ann. R. 69O-157.003 - Definition of Terms

As used in these rules and as used in long-term care policies, the following terms shall have meanings no more restrictive than the following:

(1) "Applicant" means:

(a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits.

(b) In the case of a group long-term care insurance policy, the proposed certificate holder.

(2) "Certificate" means any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this State.

(3) "Policy" means any long-term care policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this state, or delivered or issued for delivery outside this state to the extent these rules are applicable to out-of-state policies by an insurer, a fraternal benefit society, a health care services plan, a health maintenance organization, a prepaid health clinic or a multiple-employer welfare arrangement.

(4) "Nursing home" means a facility or distinctly separate part of a hospital or other institution which is licensed by the appropriate licensing agency to engage primarily in providing nursing care and related services to inpatients and provides 24-hour a day nursing service, and has a nurse on duty or on call at all times and maintains clinical records for all patients.

(5) "Medicare" means "The Health Insurance for Aged Act", Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended, or Title I, Part I of Public Law 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.

(6) "Hospital" means a hospital as defined and licensed pursuant to the provisions of Chapter 395, F.S., or pursuant to substantially similar provisions of another state's licensing laws.

(7) "Institutionalization" means that confinement to a hospital, facility, or center licensed pursuant to any Parts of Chapter 400 or Chapter 395, F.S., or pursuant to substantially similar provisions of another state's licensing laws.

Notes

Fla. Admin. Code Ann. R. 69O-157.003

Rulemaking Authority 624.308(1), 627.9407(1) FS. Law Implemented 624.307(1), 627.9407 FS.

New 5-17-89, Formerly 4-81.003, 4-157.003.

New 5-17-89, Formerly 4-81.003, 4-157.003.