Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-157 - LONG-TERM CARE INSURANCE
Section 69O-157.119 - Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts
Universal Citation: FL Admin Code R 69O-157.119
Current through Reg. 50, No. 187; September 24, 2024
(1) A qualified long term care insurance contract shall pay only for qualified long term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by a licensed health care practitioner.
(2)
(a)
1. A qualified long-term care insurance
contract shall condition the payment of benefits on a determination of the
insured's being chronically ill as defined in Section
627.9404(4),
F.S.
2. Certifications regarding
activities of daily living and cognitive impairment shall be performed by a
licensed health care practitioner as defined by Section
627.9404(6),
F.S.
(b) When a licensed
health care practitioner has certified that an insured is unable to perform
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certification shall not be rescinded and additional certifications shall not be
performed until after the expiration of the 90 day period.
(3) Qualified long-term care insurance contracts shall include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.
Rulemaking Authority 624.308(1), 627.9407(1), 627.9408 FS. Law Implemented 624.307(1), 627.9402, 627.9407(1), 627.94074 FS.
New 1-13-03, Formerly 4-157.119.
Disclaimer: These regulations may not be the most recent version. Florida may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
