760 IAC 2-6-1 - Minimum standards for home health and community care benefits

Authority: IC 27-8-12-7

Affected: IC 27-8-12

Sec. 1.

(a) A long term care insurance policy, certificate, or subscriber agreement shall not, if it provides benefits for home health and community care services, limit or exclude benefits as follows:
(1) By requiring that the insured/claimant need skilled care in a skilled nursing facility if home health care services were not provided.
(2) By requiring that the insured/claimant first or simultaneously receive nursing and/or therapeutic services in a home, community, or institutional setting before home health care services are covered.
(3) By limiting eligible services to services provided by registered nurses or licensed practical nurses.
(4) By requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide, or other licensed or certified home care worker acting within the scope of his or her licensure or certification.
(5) By requiring that the insured/claimant have an acute condition before home health care services are covered.
(6) By limiting benefits to services provided by Medicare-certified agencies or providers.
(7) By excluding coverage for personal care services provided by a home health aide.
(8) By requiring that the provision of home health care services be at a level of certification or licensure greater than that required by the eligible service.
(9) By excluding coverage for adult day care services.
(b) Home health care coverage may be applied to the nonhome health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy, certificate, or subscriber agreement.
(c) A long term care insurance policy, certificate, or subscriber agreement, if it provides for home health or community care services, shall provide total home health or community care coverage that is a dollar amount equivalent to at least one-half (1/2) of one (1) year's coverage available for nursing home benefits under the policy, certificate, or subscriber agreement, at the time covered home health or community care services are being received. This requirement shall not apply to policies, certificates, or subscriber agreements issued to residents of continuing care retirement communities.

Notes

760 IAC 2-6-1
Department of Insurance; 760 IAC 2-6-1; filed Oct 30, 1992, 12:00 p.m.: 16 IR 861; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; readopted filed Nov 27, 2007, 4:01 p.m.: 20071226-IR-760070717RFA; readopted filed November 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFA Readopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFA

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