20-1691. Definitions
In this article, unless the context otherwise requires:
1. "Applicant" means:
(a) In the case of an individual long-term care insurance policy, the person who
seeks to contract for such benefits.
(b) In the case of a group long-term care insurance policy, the proposed
certificate holder.
2. "Certificate" means a certificate issued under a group long-term care insurance
policy, which group policy has been delivered or issued for delivery in this state.
3. "Chronically ill individual" means any individual who has been certified by a
licensed health care practitioner as meeting the definition of illness established by
title III of the health insurance portability and accountability act of 1996 (P.L.
104-191).
4. "Director" means the director of the department of insurance.
5. "Group" means any of the following:
(a) One or more employers or labor organizations, or a trust or the trustees of a
fund established by one or more employers or labor organizations for employees or former
employees or members or former members of the labor organization.
(b) A professional, trade or occupational association for its members or former or
retired members if the association is composed of individuals who were all actively
engaged in the same profession, trade or occupation and the association has been
maintained in good faith for purposes other than obtaining insurance.
(c) An association or a trust or the trustees of a fund established, created or
maintained for the benefit of members of one or more associations, subject to compliance
with the requirements of section 20-1691.04, subsection A.
(d) A group other than that described in subdivision (a), (b) or (c) of this
paragraph if a policy issued to the group satisfies the criteria under section
20-1691.04, subsection C.
6. "Group long-term care insurance" means a long-term care insurance policy that is
delivered or issued for delivery in this state to a group.
7. "Licensed health care practitioner" means any physician licensed pursuant to
title 32, chapter 13 or 17, any registered nurse or registered nurse practitioner
licensed pursuant to title 32, chapter 15 or any other individual who meets the
requirements prescribed by the United States secretary of the treasury.
8. "Long-term care insurance" means an individual or group insurance policy or
rider issued by insurers, fraternal benefit societies, nonprofit health, hospital and
medical service corporations, prepaid health plans, health care services organizations or
any similar organization and advertised, marketed, offered or designed to provide
coverage for each covered person on an expense-incurred, indemnity, prepaid or other
basis for one or more necessary or medically necessary diagnostic, preventive,
therapeutic, rehabilitative, maintenance, personal or custodial care services provided in
a setting other than an acute care unit of a hospital. Long-term care insurance includes
group and individual annuities, life insurance policies or riders that provide or
supplement long-term care insurance and qualified long-term care insurance contracts.
Long-term care insurance also includes a policy or rider that provides for payment of
benefits based on cognitive impairment or loss of functional capacity. Long-term care
insurance does not include any insurance policy that is offered primarily to provide
basic medicare supplement coverage, basic hospital expense coverage, basic medical and
surgical expense coverage, major medical expense coverage, disability income or related
asset protection coverage, hospital confinement indemnity coverage, accident only
coverage, specified disease coverage, specified accident coverage or limited benefit
health coverage or riders to the insurance policy or a life insurance policy that
accelerates the death benefit for terminal illness, medical conditions requiring
extraordinary medical intervention or permanent institutional confinement, that provides
the option of a lump sum payment for those benefits and in which the benefits or the
eligibility for the benefits is not conditioned on the receipt of long-term care.
9. "Long-term care partnership program" means a qualified state long-term care
insurance partnership as defined in section 1917(b) of the social security act (42 United
States Code section 1396p).
10. "Maintenance or personal care services" means any care the primary purpose of
which is to provide assistance needed with any disability that results in the individual
being a chronically ill individual, including the protection from threats to health and
safety due to severe cognitive impairment.
11. "Policy" means an individual or group policy, contract, subscriber agreement,
rider or endorsement delivered or issued for delivery in this state by an insurer,
fraternal benefit society, nonprofit health, hospital or medical service corporation,
prepaid health plan or health care services organization or any similar organization.
12. "Preexisting condition" means a condition for which medical advice or treatment
was recommended by or received from a health care services provider within six months
before the effective date of coverage of an insured person.
13. "Qualified long-term care insurance contract" means:
(a) Any insurance policy that meets the requirements of section 7702B(b) of the
internal revenue code of 1986, as amended.
(b) The portion of a life insurance policy that provides long-term care insurance
coverage by rider or as a part of the policy and that satisfies the requirements of
section 7702B(b) and (e) of the internal revenue code of 1986, as amended.
14. "Qualified long-term care services" means necessary diagnostic, preventive,
therapeutic, curing, treating, mitigating and rehabilitative services and maintenance or
personal care services to which the insured is eligible under a qualified long-term care
insurance contract and that are provided pursuant to a plan of care prescribed by a
licensed health care practitioner.
15. "Severe cognitive impairment" means an impairment determined by a licensed
health care practitioner as meeting the definition of an impairment as established by
title III of the health insurance portability and accountability act of 1996 (P.L.
104-191).
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