(a) A
long-term care insurance policy delivered or issued for delivery in this
Commonwealth may not use the terms set forth as follows, unless the terms are
defined in the
policy and the definitions satisfy the following requirements:
Activities of daily living-Bathing,
continence, dressing, eating, toileting and transferring.
Acute condition-The term means that the
individual is medically unstable. This individual requires frequent monitoring
by medical professionals, such as physicians and registered nurses, to maintain
the individual's health status.
Adult day care-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-Washing oneself by sponge bath, or
in either a tub or shower, including the task of getting into or out of the tub
or shower.
Cognitive impairment-A deficiency in a
person's short or long-term memory, orientation as to person, place and time,
deductive or abstract reasoning, or judgment as it relates to safety awareness.
Continence-The ability to maintain control
of bowel and bladder function; or, when unable to maintain control of bowel or
bladder function, the ability to perform associated personal hygiene (including
caring for catheter or colostomy bag).
Dressing-Putting on and taking off all items
of clothing and necessary braces, fasteners or artificial limbs.
Eating-Feeding oneself by getting food into
the body from a receptacle (such as a plate, cup or table) or by a feeding tube
or intravenously.
Hands-on assistance-Physical assistance
(minimal, moderate or maximal) without which the individual would not be able
to perform the activity of daily living.
Home health care services-Medical and
nonmedical services, provided to ill, disabled or infirm persons in their
residences. The services may include homemaker services, assistance with
activities of daily living and respite care services.
Medicare-The program under the Health
Insurance for the Aged Act in Title XVIII of the Social Security Amendments of
1965 (42 U.S.C.A.
§§
1395-1395gg g) and any
later amendments or substitutes thereof.
Mental or nervous disorder-The term may not
be defined to include more than neurosis, psychoneurosis, psychopathy,
psychosis, or mental or emotional disease or disorder.
Personal care-The provision of supervisory
or hands-on services to assist an individual with activities of daily living.
Skilled nursing care, intermediate care, personal
care, home care and other services-These terms shall be defined in
relation to the level of skill required, the nature of the care and the setting
in which care must be delivered.
Toileting-Getting to and from the toilet,
getting on and off the toilet and performing associated personal hygiene.
Transferring-Moving into or out of a bed,
chair or wheelchair.
