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 3601.29 - Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts
Current through Register No. 12, March 21, 2024
(a) For purposes of this section the following definitions apply:
(b) 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.
(c) A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's inability to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity or to severe cognitive impairment.
(d) Certifications regarding activities of daily living and cognitive impairment required pursuant to (c) shall be performed by the following licensed or certified professionals: physicians, registered professional nurses, licensed social workers, or other individuals who meet requirements prescribed by the Secretary of the Treasury.
(e) Certifications required pursuant to (c) may be performed by a licensed health care professional at the direction of the carrier as is reasonably necessary with respect to a specific claim, except that 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at least 90 days due to a loss of functional capacity and the insured is in claim status, the certification may not be rescinded and additional certifications may not be performed until after the expiration of the 90 day period.
(f) Qualified long-term care insurance contracts shall include a clear description of the process of appealing and resolving disputes with respect to benefit determinations.
#8036, eff 5-1-04; ss by #10154, eff 6-25-12 (from Ins 3601.27 )
The amended version of this section by New Hampshire Register Volume 35, Number 10, eff.2/13/2015 is not yet available.