New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 39 - Minimum Standards For The New York State Partnership For Long-term Care Program › Section 39.7 - Minimum benefit standards for qualified policies/certificates for the 2/4/50 plan design

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Basic
				  program minimum coverage requirements. All program participating insurers
				  issuing this plan design shall offer a basic policy/certificate providing
				  minimum coverage under this section and may also offer coverage exceeding the
				  minimum daily benefit amounts under this section. The insurer selling a
				  policy/certificate providing minimum coverage under this section also must
				  offer a policy/certificate providing the basic 1.5/3/50 minimum plan design and
				  the basic 2/2/100 minimum plan design under sections
				  39.4 and
				  39.6  of this Part to the
				  prospective insured at the same time.
(b) Minimum benefit standards for the 2/4/50
				  plan design. To be approved as a qualified policy/certificate under this
				  section a policy/certificate shall provide coverage on an expense incurred,
				  indemnity, prepaid, or other basis and provide at least the following benefits:
(1) Nursing home care. Nursing home care coverage shall be provided
				  for not less than a lifetime maximum total of 24 months for each covered
				  person. A covered person must be permitted to substitute home and
				  community-based care benefits or residential care facility benefits for nursing
				  home care benefits on the basis of two home and community-based care or
				  residential care facility service days for one nursing home day. Coverage of
				  nursing home care shall consist of payment for skilled nursing care,
				  intermediate care, and custodial care in nursing homes of at least $ 387 per
				  day. Payment for nursing home care services may be limited to services rendered
				  in a nursing home licensed by the jurisdiction in which it is located. The
				  minimum nursing home daily benefit shall be increased each year on the first
				  day of January beginning in 2024. Policies/certificates sold on or after
				  January 1, 2025 shall provide benefits at the increased minimum standard in the
				  year sold. Minimum daily benefits for the years listed below shall be as
				  follows:
(i) January 1, 2024 - $ 387 (nursing
				  home), $ 193 (residential care facility and home and community-based care - 50
				  percent);
(ii) January 1, 2025 - $
				  401 (nursing home), $ 200 (residential care facility and home and
				  community-based care - 50 percent);
(iii) January 1, 2026 - $ 415 (nursing home),
				  $ 207 (residential care facility and home and community-based care - 50
				  percent);
(iv) January 1, 2027 - $
				  430 (nursing home), $ 215 (residential care facility and home and
				  community-based care - 50 percent);
(v) January 1, 2028 - $ 445 (nursing home), $
				  222 (residential care facility and home and community-based care - 50
				  percent);
(vi) January 1, 2029 - $
				  461 (nursing home), $ 230 (residential care facility and home and
				  community-based care - 50 percent);
(vii) January 1, 2030 - $ 477 (nursing home),
				  $ 238 (residential care facility and home and community-based care - 50
				  percent);
(viii) January 1, 2031 - $
				  494 (nursing home), $ 247 (residential care facility and home and
				  community-based care - 50 percent);
(ix) January 1, 2032 - $ 511 (nursing home),
				  $ 255 (residential care facility and home and community-based care - 50
				  percent);
(x) January 1, 2033 - $
				  529 (nursing home), $ 264 (residential care facility and home and
				  community-based care - 50 percent).