Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.90-006 - Rule and Regulation 13: Long-Term Care Insurance

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1. PURPOSE
The purposes of this Regulation are to implement Act 642 of 1989,
			 to promote the public interest, to promote the availability of long-term care
			 insurance coverage, to protect applicants for long-term care insurance, as
			 defined, from unfair or deceptive sales or enrollment practices, to facilitate
			 public understanding and comparison of long-term care insurance coverages, and
			 to facilitate flexibility and innovation in the development of long-term care
			 insurance.
SECTION 2.
		  AUTHORITY
This Regulation is issued pursuant to the authority vested in the
			 Commissioner under Act 642 of 1989, and Ark. Code Ann. §§
								23-61-108, and
			 25-15-202,
			 et seq.
SECTION 3.
		  APPLICABILITY AND SCOPE
Except as otherwise specifically provided, this Regulation
			 applies to all long-term care insurance policies, contracts, certificates,
			 riders or other evidence of coverage issued, delivered or issued for delivery,
			 advertised, marketed or offered in this State on or after the effective date
			 hereof, by insurers; fraternal benefit societies; nonprofit health, hospital
			 and medical service corporations; prepaid health plans; health maintenance
			 organizations; and all similar organizations.
SECTION 4. DEFINITIONS
For the purpose of this Regulation, the terms "long-term care
			 insurance", "group long-term care insurance", "Commissioner", "applicant",
			 "policy" and "certificate" shall have the meanings set forth in Section 4 of
			 Act 642 of 1989.
SECTION 5.
		  POLICY DEFINITIONS
No long-term care insurance policy issued, delivered or issued
			 for delivery in this State shall use the terms set forth below, unless the
			 terms are defined in the policy and the definitions satisfy the following
			 requirements:
A. "Medicare" shall be
		  defined as "The Health Insurance for the Aged Act, Titled XVIII of the Social
		  Security Amendments of 1965 as Then Constituted or Later Amended", or "Titled
		  I, Part I of Public Law
		  89-97, as Enacted by the Eighty-Ninth Congress of
		  the United States of America popularly known as the Health Insurance for the
		  Aged Act, as then constituted and any later amendments or substitutes thereof",
		  or words of similar import.
B.
		  "Mental or nervous disorder" shall not be defined to include more than
		  neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional
		  disease or disorder.
C. "Skilled
		  nursing care", "intermediate care", "personal care", "home care", and other
		  services shall be defined in relation to the level of skills required, the
		  nature of the care, and the setting in which care must be delivered.
D. All providers of services, including but
		  not limited to "skilled nursing facility", "extended care facility",
		  "intermediate care facility", convalescent nursing home", "personal care
		  facility", and "home care agency" shall be defined in relation to the services
		  and facilities required to be available and the licensure or degree status of
		  those providing or supervising the services. The definition may require that
		  the provider be appropriately licensed or certified.