58-17B-7.   Requirements for long-term care insurance policies--Post-confinement, post-acute care, or recuperative benefits. No long-term care insurance policy may be delivered or issued for delivery in this state if the policy:

             (1)      Conditions eligibility for any benefits on a prior hospitalization requirement;

             (2)      Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or

             (3)      Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement.

     Post-confinement, post-acute care, or recuperative benefits do not include home health care, adult day care, or any other benefit based on treatment or services received.

     A long-term care insurance policy, continuing post-confinement, post-acute care, or recuperative benefits, shall clearly label, in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits," such limitations or conditions, including any required number of days of confinement.

     A long-term care insurance policy or rider which conditions eligibility of non-institutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than thirty days, except waiver of premium which may not require a prior institutional stay of more than ninety days.

Source: SL 1989, ch 440, § 7; SL 1991, ch 401.

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