Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1003 - Policy Terms

Current through Register Vol. 30, No. 28, July 12, 2024
A. A long-term care
				insurance policy delivered or issued for delivery in this state shall not 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 eating,
				toileting, transferring, bathing, dressing, or continence.
2. "Acute condition" means that an individual
				is medically unstable and requires frequent monitoring by medical
				professionals, such as physicians and registered nurses, to maintain the
				individual's health status.
3.
				"Adult day care" means a program of social and health-related services for six
				or more individuals, that is 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 the services and care in a setting outside
				the home.
4. "Agent" means an
				insurance producer as defined in A.R.S. §
										20-281(5).
5. "Bathing" means washing oneself by sponge
				bath, or in a tub or shower, and includes the act of getting in and out of the
				tub or shower.
6. "Chronically ill
				individual" has the meaning prescribed for this term by A.R.S. §
										20-1691(3)  and
				Section 7702B(c)(2) of the Internal Revenue Code of 1986, as amended.
a. Under this provision, a chronically ill
				individual means any individual who has been certified by a licensed health
				care practitioner as:
i. Being unable to
				perform (without substantial assistance from another individual) at least 2
				activities of daily living for a period of at least 90 days due to loss of
				functional capacity; or
ii.
				Requiring substantial supervision to protect the individual from threats to
				health and safety due to severe cognitive impairment.
b. The term "chronically ill individual" does
				not include an individual otherwise meeting these requirements unless within
				the preceding twelve-month period a licensed health care practitioner has
				certified that the individual meets these requirements.
7. "Cognitive impairment" means a deficiency
				in a person's:
a. Short or long-term
				memory;
b. Orientation as to
				person, place, or time;
c.
				Deductive or abstract reasoning; or
d. Judgment as it relates to safety
				awareness.
8.
				"Continence" means the ability to maintain control of bowel and bladder
				function, or when unable to maintain control, the ability to perform associated
				personal hygiene, such as caring for a catheter or colostomy bag.
9. "Dressing" means putting on and taking off
				all items of clothing and any necessary braces, fasteners, or artificial
				limbs.
10. "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.
11. "Guaranteed renewable" means the insured
				has the right to continue a long-term-care insurance policy in force by the
				timely payment of premiums and the insurer has no unilateral right to make any
				change in any provision of the policy or rider while the insurance is in force,
				and cannot decline to renew, except that the insurer may revise rates on a
				class basis.
12. "Hands-on
				assistance" means physical help to an individual who could not perform an
				activity of daily living without help from another individual, and includes
				minimal, moderate, or maximal help.
13. "Home health services" means the services
				described at A.R.S. §
										36-151.
14. "Level premium" means that an insurer
				does not have any right to change the premium, even at renewal.
15. "Licensed health care practitioner" has
				the same meaning as A.R.S. §
										20-1691(6).
16. "Maintenance or personal care services"
				has the same meaning as A.R.S. §
										20-1691(10).
17. "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.
18. "Noncancellable" means the insured has
				the right to continue the long-term care insurance in force by the timely
				payment of premiums during which period the insurer has no right to
				unilaterally cancel or make any change in any provision of the insurance or in
				the premium rate.
19. "Personal
				care" means the provision of hands-on assistance to help an individual with
				activities of daily living in relation to the level of skill required, the
				nature of the care, and the setting in which the care must be
				delivered.
20. "Qualified long-term
				care services" has the meaning prescribed for this term under A.R.S. §
										20-1691(13)  and
				means services that meet the requirements of Section 7702B(c)(1) of the
				Internal Revenue Code of 1986, as amended, as follows: necessary diagnostic,
				preventative, therapeutic, curing, treating, mitigating and rehabilitative
				services, and maintenance or personal care services which are required by a
				chronically ill individual, and are provided pursuant to a plan of care
				prescribed by a licensed health care practitioner.
21. "Toileting" means getting to and from the
				toilet, getting on and off the toilet, and performing tasks associated with
				personal hygiene.
22.
				"Transferring" means moving into or out of a bed, chair, or
				wheelchair.