Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-16 - LONG TERM CARE INSURANCE › Rule 120-2-16-.05 - Policy Definitions

Current through Rules and Regulations filed through June 27, 2024
No long-term care insurance policy 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:
(1) "Activities of daily
				living" means at least bathing, continence, dressing, eating, toileting and
				transferring.
(2) "Acute condition"
				means that the individual is medically unstable. Such an individual requires
				frequent monitoring by medical professionals, such as physicians and registered
				nurses, in order to maintain his or her health status.
(3) "Adult day care" means a program for six
				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.
(4) "Bathing"
				means 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.
(5) "Cognitive impairment" means 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.
(6) "Continence" means
				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).
(7) "Dressing" means putting
				on and taking off all items of clothing and any necessary braces, fasteners or
				artificial limbs.
(8) "Eating"
				means 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.
(9) "Hands-on assistance" means physical
				assistance (minimal, moderate or maximal) without which the individual would
				not be able to perform the activity of daily living.
(10) "Home health care services" means
				medical and nonmedical 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.
(11) "Medicare" means "The Health Insurance
				for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then
				Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as
				Enacted by the Eighty-Ninth Congress of the United States of America and
				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.
(12) "Mental or nervous
				disorder" shall not be defined to include more than neurosis, psychoneurosis,
				psychopathy, psychosis, or mental or emotional disease or disorder.
(13) "Personal care" means the provision of
				hands-on services to assist an individual with activities of daily
				living.
(14) "Skilled nursing
				care," "personal care," "home care," "specialized care," "assisted living care"
				and other services shall be defined in relation to the level of skill required,
				the nature of the care and the setting in which care must be
				delivered.
(15) "Toileting" means
				getting to and from the toilet, getting on and off the toilet, and performing
				associated personal hygiene.
(16)
				"Transferring" means moving into or out of a bed, chair or
				wheelchair.
(17) All providers of
				services, including but not limited to "skilled nursing facility," "extended
				care facility," "convalescent nursing home," "personal care facility,"
				"specialized care providers," "assisted living facility," and "home care
				agency" shall be defined in relation to the services and facilities required to
				be available and the licensure, certification, registration or degree status of
				those providing or supervising the services. When the definition requires that
				the provider be appropriately licensed, certified or registered, it shall also
				state what requirements a provider must meet in lieu of licensure,
				certification or registration when the state in which the service is to be
				furnished does not require a provider of these services to be licensed,
				certified or registered, or when the state licenses, certifies or registers the
				provider of services under another name.
O.C.G.A. Secs.
				  33-2-9,
				  33-42-6,
				  33-42-7,
				  49-4-164,
				  49-4-165.