Section R590-148-9 - Benefit Trigger Standards for Qualified Long-Term Care Insurance Contracts(1) A qualified long-term care insurance contract shall pay only for qualified long-term care services received by a chronically ill individual provided under a plan of care prescribed by a licensed health care practitioner.(2) A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's inability to perform the activities of daily living for an expected period of at least 90 days due to a loss of functional capacity or severe cognitive impairment.(3) A certification regarding the activities of daily living or cognitive impairment required under Subsection R590-148-9(2) shall be performed by a licensed or certified:(b) registered professional nurse;(d) another individual who meets the requirements prescribed by the Secretary of the Treasury.(4)(a) Except as provided in Subsection (4)(b), a certification required under Subsection (2) may be performed by a licensed health care professional at the direction of the insurer as reasonably necessary for a specific claim.(b) When a licensed health care practitioner certifies that an insured is unable to perform the activities of daily living for an expected period of at least 90 days due to a loss of functional capacity and the insured is in claim status, the certification may not be rescinded and an additional certification may not be performed until after the expiration of the 90-day period.(5) A qualified long-term care insurance contract shall include a clear description of the process for appealing and resolving a dispute with respect to a benefit determination.Utah Admin. Code R590-148-9
Adopted by Utah State Bulletin Number 2024-21, effective 10/22/2024