Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.11 - LONG-TERM CARE INSURANCE MINIMUM STANDARDS › Section 18.04.11.011 - POLICY DEFINITIONS

Current through August 31, 2023
For the purpose of this rule, no long-term care insurance
				policy delivered or issued for delivery in this state may use the terms set
				forth below, unless the terms are defined in the policy. In relation to the
				Qualified Long-Term Care plans, such definitions are to satisfy definitions as
				amended by the U.S. Treasury Department and the following requirements.
				(3-31-22)
01.
Activities of
			 Daily Living
. At least bathing, continence, dressing, eating, toileting,
			 and transferring. (3-31-22)
02.
Acute Condition
. The individual is medically unstable. Such an
			 individual requires frequent monitoring by medical professionals, such as
			 physicians and registered nurses, to maintain the individual's health status.
			 (3-31-22)
03.
Adult Day
			 Care
. A program for six (6) or more individuals, of social and
			 health-related services provided during the day in a community group setting
			 for the purpose of supporting frail, impaired elderly or other disabled adults
			 who can benefit from care in a group setting outside the home.
			 (3-31-22)
04.
Bathing
.
			 Washing oneself by sponge bath; or in either a tub or shower, including the
			 task of getting into or out of the tub or shower. (3-31-22)
05.
Cognitive Impairment
. A
			 deficiency in a person's short or long-term memory, orientation as to person,
			 place and time, deductive or abstract reasoning, or judgment as it relates to
			 safety awareness. (3-31-22)
06.
Continence
. The ability to maintain control of bowel and bladder
			 function; or, when unable to maintain control of bowel or bladder function, the
			 ability to perform associated personal hygiene (including caring for catheter
			 or colostomy bag). (3-31-22)
07.
Dressing
. Putting on and taking off all items of clothing and any
			 necessary braces, fasteners, or artificial limbs. (3-31-22)
08.
Eating
. Feeding oneself by
			 getting food into the body from a receptacle (such as a plate, cup, or table)
			 or by a feeding tube or intravenously. (3-31-22)
09.
Hands-On Assistance
.
			 Physical assistance (minimal, moderate, or maximal) without which the
			 individual would not be able to perform the activity of daily living.
			 (3-31-22)
10.
Home Health
			 Care Services
. Medical and non-medical services, provided to ill,
			 disabled, or infirm persons in their residences. Such services may include
			 homemaker services, assistance with activities of daily living, and respite
			 care services. (3-31-22)
11.
Mental or Nervous Disorder
. Limited to neurosis, psychoneurosis,
			 psychopathy, psychosis, or mental or emotional disease or disorder.
			 (3-31-22)
12.
Personal
			 Care
. The provision of hands-on services to assist an individual with
			 activities of daily living. (3-31-22)
13.
Similar Policy Forms
. Means
			 all of the long-term care insurance policies and certificates issued by an
			 insurer in the same long-term care benefit classification as the policy form
			 being considered. Certificates of groups that meet the definition in Section
			 41-4603(4)(a),
			 Idaho Code, are not considered similar to certificates or policies issued as
			 long-term care insurance, but are similar to other comparable certificates with
			 the same long-term care benefit classifications. For purposes of determining
			 similar policy forms, long-term care benefit classifications are defined as
			 follows: (3-31-22)
a. Institutional long-term
			 care benefits only; (3-31-22)
b.
			 Non-institutional long-term care benefits only; or (3-31-22)
c. Comprehensive long-term care benefits.
			 (3-31-22)