Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 425 - LONG-TERM CARE INSURANCE › Section 031-425-5 - Policy Definitions

Current through 2024-29, July 17, 2024
No long-term care insurance policy shall use the terms set
				  forth in this section unless the terms are defined in the policy and are
				  consistent with the following definitions:
A. "Activities of daily living" means, at a
				minimum, bathing, continence, dressing, eating, toileting and
				transferring.
B. "Acute condition"
				means that the individual is medically unstable and 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
				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 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-term or long-term memory, orientation as to person, place
				or time, deductive or abstract reasoning, or judgment as it relates to safety
				awareness.
F. "Continence" means
				the ability to maintain control of bowel or bladder functions, or, when unable
				to maintain such control, the ability to perform associated personal hygiene,
				including caring for a catheter or colostomy bag.
G. "Dressing" means putting on and taking off
				all items of clothing and any necessary brace, fastener or artificial
				limb.
H. "Eating" means feeding by
				getting food into the body from a receptacle (such as a plate, cup or table) or
				by a feeding tube or intravenous line.
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 non-medical services rendered in their residences to ill, disabled or
				infirm persons, including homemaker services, assistance with activities of
				daily living and respite care.
K.
				"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.
L. "Mental or nervous disorder" means any one
				of the following: neurosis, psychoneurosis, psychopathy, psychosis, or other
				mental or emotional disease or disorder.
M. "Personal care" means the rendering of
				hands-on services by another person to assist the individual in the activities
				of daily living.
N. "Skilled
				nursing care," "personal care," "home care," "specialized care," "assisted
				living care" and other service described in the policy shall be defined in
				relation to the level of skill required, the nature of the care and the setting
				in which the services are provided.
O. "Skilled nursing facility," "extended care
				facility," "convalescent nursing home," "personal care facility," "specialized
				care providers," "assisted living facility," and "home care agency" and all
				other service providers shall be defined in relation to the facilities and the
				required available services, together with the licensure, certification,
				registration or degree status of the persons who provide services and those who
				supervise 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.
P. "Toileting"
				means getting to and from the toilet, getting on and off the toilet, and
				performing associated personal hygiene.
Q. "Transferring" means moving into or out of
				a bed, chair or wheelchair.