Utah Admin. Code R590-285-11 - Minimum Standards for Home and Community Care Benefits in a Limited Long-Term Care Insurance Policy
(1) If a
policy or certificate provides benefits for home care or community care
services, it may not limit or exclude benefits by:
(a) requiring that the insured would need
care in a skilled nursing facility if home care services are not
provided;
(b) requiring the insured
to first or simultaneously receive nursing or therapeutic services, or both, in
a home, community, or institutional setting before covering home care
services;
(c) limiting eligible
services to services provided by a registered nurse or a licensed practical
nurse;
(d) requiring that a nurse
or therapist provide covered services that can be provided by a home health
aide or other licensed or certified home care worker acting within the scope of
their licensure or certification;
(e) excluding coverage for personal care
services provided by a home health aide;
(f) requiring that the provision of home care
services be at a level of certification or licensure greater than that required
for the eligible service;
(g)
requiring that the insured have an acute condition before covering home care
services;
(h) limiting benefits to
services provided by a Medicare-certified agency or provider; or
(i) excluding coverage for adult day care
services.
(2)
(a) A policy or certificate, if it provides
for home care or community care services, shall provide total home care or
community care coverage that is a dollar amount equivalent to at least one-half
of the coverage available for nursing home benefits under the policy or
certificate, at the time covered home care or community care services are
received.
(b) The requirement in
Subsection (2)(a) does not apply to a policy or certificate issued to a
resident of a continuing care retirement community.
(3) Home care coverage may be applied to
non-home care benefits provided in the policy or certificate when determining
maximum coverage under the terms of the policy or certificate.
Notes
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