Section 5051-A - Required and prohibited provisions1.Prohibited provisions. A long-term care policy may not: A. Contain coverage for skilled nursing facilities only; [1989, c. 556, Pt. B, §3(NEW).]B. Exclude coverage for skilled, intermediate or custodial care received by a resident of a skilled nursing or intermediate care facility; [1989, c. 556, Pt. B, §3(NEW).]C. Require a prior hospital stay as a condition for any policy benefits; [1989, c. 556, Pt. B, §3(NEW).]D. Require a prior skilled nursing facility stay as a condition for intermediate care facility benefits; or [1989, c. 556, Pt. B, §3(NEW).]E. Require prior institutionalization as a condition of receipt of home health care benefits. [1989, c. 556, Pt. B, §3(NEW).] [1989, c. 556, Pt. B, §3(NEW).]
2.Required provisions. A long-term care policy must provide: A. Custodial care benefits that are at least 50% of those provided for skilled nursing care in a nursing facility provided that the benefits need not exceed usual, customary and reasonable charges; [1989, c. 556, Pt. B, §3(NEW).]B. Benefits for home health care services rendered by a home health care provider; [1989, c. 556, Pt. B, §3(NEW).]C. Home health care coverage for at least 90 visits in any continuous 12-month period during which coverage is in force; and [1989, c. 556, Pt. B, §3(NEW).]D. Per visit benefits for home health care services which are at least 50% of the daily benefit for skilled nursing facility confinement provided that the benefit need not exceed usual, customary and reasonable charges. [1989, c. 556, Pt. B, §3(NEW).] [1989, c. 556, Pt. B, §3(NEW).]
1989, c. 556, §B3 (NEW) .