Nevada Administrative Code
Chapter 687B - Contracts of Insurance
CONTRACTS FOR LONG-TERM CARE
Section 687B.084 - Requirements relating to qualified long-term care insurance contract

Universal Citation: NV Admin Code 687B.084

Current through December 31, 2024

1. A qualified long-term care insurance contract must pay only for qualified long-term care services:

(a) Received by a chronically ill individual; and

(b) Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

2. The payment of benefits under a qualified long-term care insurance contract must be conditioned on a certification of the inability of the insured to perform the activities of daily living for an expected period of at least 90 days because of a loss of functional capacity or severe cognitive impairment.

3. Certifications pursuant to subsection 2 regarding activities of daily living and cognitive impairment:

(a) Must be performed by a licensed health care practitioner.

(b) May be performed by a licensed health care practitioner at the direction of the insurer as is reasonably necessary with respect to a specific claim, except that if 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90 days because of a loss of functional capacity and the insured is receiving benefits, the certification may not be rescinded and additional certifications must not be performed until after the expiration of the 90-day period.

4. A qualified long-term care insurance contract must include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.

5. As used in this section:

(a) "Chronically ill individual" has the meaning ascribed to it in 26 U.S.C. § 7702 B(c)(2).

(b) "Licensed health care practitioner" means a person licensed pursuant to chapters 630 to 633, inclusive, of NRS, a licensed social worker or other individual who meets the requirements prescribed by the Secretary of the Treasury pursuant to 26 U.S.C. § 7702 B(c)(4).

Added to NAC by Comm'r of Insurance by R121-07, 9-18-2008, eff. 10-1-2008

NRS 679B.130

Disclaimer: These regulations may not be the most recent version. Nevada 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.

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