New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 3600 - LONG-TERM CARE INSURANCE
Part Ins 3601 - LONG-TERM CARE INSURANCE
Section Ins 3601.28 - Standards for Benefit Triggers
Current through Register No. 12, March 21, 2024
(a) A long-term care insurance policy shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits shall not be more restrictive than requiring either a deficiency in the ability to perform not more than 3 of the activities of daily living or the presence of cognitive impairment.
(b)
(c) An insurer may use additional provisions for the determination of when benefits are payable under a policy or certificate; however the provisions shall not restrict, and are not in lieu of, the requirements contained in (a) and (b).
(d) For purposes of this section the determination of a deficiency shall not be more restrictive than:
(e) Assessments of activities of daily living and cognitive impairment shall be performed by licensed or certified professionals, such as physicians, nurses or social workers.
(f) Long-term care insurance policies shall include a clear description of the process for appealing and resolving benefit determinations.
(g) The requirements set forth in this section shall be applicable 12 months after the adoption of this rule and shall apply as follows:
#8036, eff 5-1-04; ss by #10154, eff 6-25-12 (from Ins 3601.26 )
The amended version of this section by New Hampshire Register Volume 35, Number 10, eff.2/13/2015 is not yet available.