No long-term care insurance policy shall use the terms set
forth in this section unless the terms are defined in the policy and are
consistent with the following definitions:
A. "Activities of daily living" means, at a
minimum, bathing, continence, dressing, eating, toileting and
B. "Acute condition"
means that the individual is medically unstable and requires frequent
monitoring by medical professionals, such as physicians and registered nurses,
in order to maintain his or her health status.
C. "Adult day care" means a program for six
or more individuals of social and health-related services provided during the
day in a community group setting, for the purpose of supporting frail,
impaired, elderly or other disabled adults who can benefit from care in a group
setting outside the home.
"Bathing" means washing oneself by sponge bath, or in a tub or shower,
including the task of getting into or out of the tub or shower.
E. "Cognitive impairment" means a deficiency
in a person's short-term or long-term memory, orientation as to person, place
or time, deductive or abstract reasoning, or judgment as it relates to safety
F. "Continence" means
the ability to maintain control of bowel or bladder functions, or, when unable
to maintain such control, the ability to perform associated personal hygiene,
including caring for a catheter or colostomy bag.
G. "Dressing" means putting on and taking off
all items of clothing and any necessary brace, fastener or artificial
H. "Eating" means feeding by
getting food into the body from a receptacle (such as a plate, cup or table) or
by a feeding tube or intravenous line.
I. "Hands-on assistance" means physical
assistance (minimal, moderate or maximal) without which the individual would
not be able to perform the activity of daily living.
J. "Home health care services" means medical
and non-medical services rendered in their residences to ill, disabled or
infirm persons, including homemaker services, assistance with activities of
daily living and respite care.
"Medicare" means "The Health Insurance for the 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.
L. "Mental or nervous disorder" means any one
of the following: neurosis, psychoneurosis, psychopathy, psychosis, or other
mental or emotional disease or disorder.
M. "Personal care" means the rendering of
hands-on services by another person to assist the individual in the activities
of daily living.
nursing care," "personal care," "home care," "specialized care," "assisted
living care" and other service described in the policy shall be defined in
relation to the level of skill required, the nature of the care and the setting
in which the services are provided.
O. "Skilled nursing facility," "extended care
facility," "convalescent nursing home," "personal care facility," "specialized
care providers," "assisted living facility," and "home care agency" and all
other service providers shall be defined in relation to the facilities and the
required available services, together with the licensure, certification,
registration or degree status of the persons who provide services and those who
supervise the services. When the definition requires that the provider be
appropriately licensed, certified or registered, it shall also state what
requirements a provider must 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 these services to be licensed, certified or registered,
or when the state licenses, certifies or registers the provider of services
under another name.
means getting to and from the toilet, getting on and off the toilet, and
performing associated personal hygiene.
Q. "Transferring" means moving into or out of
a bed, chair or wheelchair.