Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.05 - Policy Definitions

Current through Register Vol. 42, No. 9, June 28, 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:
(a) "Activities of daily
			 living" means at least bathing, continence, dressing, eating, toileting and
			 transferring.
(b) "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.
(c) "Adult day care" means 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.
(d)
			 "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.
(e) "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.
(f) "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).
(g) "Dressing" means putting
			 on and taking off all items of clothing and any necessary braces, fasteners or
			 artificial limbs.
(h) "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.
(i) "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.
(j) "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.
(k) "Medicare" shall be defined as "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.
(l) "Mental or
			 nervous disorder" shall not be defined to include more than neurosis,
			 psychoneurosis, psychopathy, psychosis, or mental or emotional disease or
			 disorder.
(m) "Personal care" means
			 the provision of hands-on services to assist an individual with activities of
			 daily living.
(n) "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.
(o) "Toileting" means
			 getting to and from the toilet, getting on and off the toilet, and performing
			 associated personal hygiene.
(p)
			 "Transferring" means moving into or out of a bed, chair or
			 wheelchair.
(q) 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.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.