Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37e - Long-term care insurance; prohibitions

Current through Register Vol. 43, No. 28, July 11, 2024
Each long-term care policy shall be prohibited from the
				following:
(a) Containing more than
			 one elimination period for periods of confinement in a nursing home that are
			 due to the same or related causes and separated from each other by less than
			 six months;
(b) excluding coverage
			 for confinement to an intermediate nursing facility if benefits for nursing
			 care are provided;
(c) providing
			 coverage for skilled nursing care only or providing significantly more coverage
			 for skilled care in a facility than coverage for lower levels of
			 care;
(d) being delivered or issued
			 for delivery to any person in this state, unless every printed portion of the
			 text of the policy is plainly printed in not less than 10-point type;
(e) requiring prior confinement to a hospital
			 or prior confinement for a greater level of nursing care as a condition for
			 paying inpatient benefits;
(f)
			 being delivered in this state, unless the following notice is attached to the
			 policy:
"IMPORTANT NOTICE Please read the copy of the application
				attached to this policy. Carefully check the application and write to the
				company within 30 days if any information shown is incorrect or incomplete or
				if any past medical history has been left out of the application. This
				application is a part of the policy and the policy was issued on the basis that
				answers to all questions and the information shown on the application are
				correct and complete."
This statement, preferably in the form of a sticker to be
				placed on the policy, shall be printed in a prominent manner on paper or in ink
				of a contrasting color. The insurer may, with the approval of the commissioner
				of insurance, substitute wording of similar import if equal results are
				obtained. This requirement shall not apply if the application for insurance is
				not attached to and made a part of the contract;
(g) being cancelled, nonrenewed, or otherwise
			 terminated on the grounds of the age or the deterioration of the mental or
			 physical health of the insured individual or certificate holder; and
(h) if the policy provides benefits for home
			 health care or community care services, limiting or excluding benefits by any
			 of the following means:
(1) Requiring that the
			 insured or claimant would need care in a skilled nursing facility if home
			 health care services were not provided;
(2) requiring that the insured or claimant
			 first or simultaneously receive nursing or therapeutic services in a home,
			 community, or institutional setting before home health care services are
			 covered;
(3) limiting eligible
			 services to services provided by registered nurses or licensed practical
			 nurses;
(4) requiring that a nurse
			 or therapist provide services covered by the policy if the services can be
			 provided instead by a home health aide or other licensed or certified home care
			 worker acting within the scope of the home care worker's licensure or
			 certification;
(5) excluding
			 coverage for personal care services provided by a home health aide;
(6) requiring that the provision of home
			 health care services be at a level of certification or licensure greater than
			 that required by the eligible service;
(7) requiring that the insured or claimant
			 have an acute condition before home health care services are covered;
(8) limiting benefits to only those services
			 provided by medicare-certified agencies or providers; or
(9) excluding coverage for adult day care
			 services.