760 Ind. Admin. Code 2-20-21

Current through December 12, 2024
Section 760 IAC 2-20-21 - "Insured event" defined

Authority: IC 27-8-12-7.1

Affected: IC 12-15-2

Sec. 21.

(a) Except as specified in subsection (b), as used in this rule, "insured event" means, for the purposes of determining eligibility for benefits under a qualified policy, or certificate, or rider and for determining whether these benefits result in an asset disregard for a qualified insured, that any one (1) of the following criteria is met:
(1) The individual has a deficiency in two (2) or more activities of daily living.
(2) The individual has a cognitive impairment.
(3) The individual has a complex, unstable medical condition.
(b) For qualified policies eligible for favorable tax status, "insured event" means when the policyholder has become a "chronically ill individual" as that term is defined in the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, Sections 321 through 327 , hereinafter referred to as "HIPAA 1996". When determining the loss of functional capacity, the policyholder must be unable to perform (without substantial assistance from another individual) two (2) or more of six (6) activities of daily living (as set forth in HIPAA 1996) for a period of at least ninety (90) days.

760 IAC 2-20-21

Department of Insurance; 760 IAC 2-20-21; filed Nov 20, 1992, 9:00 a.m.: 16 IR 1147; filed Jun 15, 1994, 10:00 a.m.: 17 IR 2644; filed Jul 28, 1997, 1:50 p.m.: 20 IR 3369; errata, 21 IR 111; 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
Readopted filed 11/30/2022, 11:39 a.m.: 20221228-IR-760220302RFA