New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 34 - LONG-TERM CARE INSURANCE
Section 11:4-34.10 - Minimum standards for home health and community care benefits in long-term care insurance policies and certificates

Universal Citation: NJ Admin Code 11:4-34.10

Current through Register Vol. 56, No. 18, September 16, 2024

(a) A long-term care insurance policy or certificate, if it provides benefits for home health care or community care services, shall not limit or exclude benefits:

1. By requiring that the insured would need care in a skilled nursing facility if home health care services were not provided;

2. By requiring that the insured first or simultaneously receive nursing or therapeutic services, or both, in a home, community or institutional setting before home health care services are covered;

3. By limiting eligible services to services provided by registered nurses or licensed practical nurses;

4. By requiring that a nurse or therapist provide covered services that can be provided by a home health aide, or other licensed or certified home care worker acting within the scope of his or her licensure or certification;

5. By excluding coverage for the personal care services provided by a home health aide;

6. By requiring that the provision of home health care services be at a level of certification or licensure greater than that required by the eligible service;

7. By requiring that the insured have an acute condition before home health care services are covered;

8. By limiting benefits to services provided by Medicare-certified agencies or providers; or

9. By excluding coverage for adult day care services,

(b) A long-term care insurance policy or certificate that provides for home health or community care services shall provide total home health or community care coverage in a dollar amount equivalent to at least one- half of one year's coverage available for nursing home benefits under the policy or certificate, at the time covered home health or community care services are being received. This requirement shall not apply to policies or certificates issued to residents of continuing care retirement communities.

(c) Home health care coverage may be applied to the non-home health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.

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