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 39.4 - Minimum benefit standards for qualified policies/certificates for the 1.5/3/50 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 must offer a basic policy/certificate providing
				  minimum coverage under this section. Additional products which exceed the basic
				  policy/certificate minimum coverage will be permitted, but no more than a
				  2.5/5/50 (maximums of 2.5 years of nursing home coverage and 5 years of home
				  care coverage) plan design shall be offered under this section. The insurer
				  selling a policy/certificate providing minimum coverage under this section must
				  offer a policy/certificate providing the basic 2/2/100 minimum plan design
				  under section
				  39.6  of this Part to the
				  prospective insured at the same time.
(b) Minimum benefit standards for the
				  1.5/3/50 plan design. To be approved as a qualified policy/certificate under
				  this section, a policy/certificate shall provide coverage on an expense
				  incurred basis for 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 18
				  months for each covered person. A covered person must be permitted to
				  substitute home care benefits for nursing home care benefits on the basis of
				  two home care 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 2025. Policies/certificates sold after January 1, 2025 shall
				  provide benefits at the increased minimum standard in the year sold. Minimum
				  daily benefits for the next 10 years shall be as follows:
(i) January 1, 2024 - $ 387 (nursing home), $
				  193 (home care - 50 percent);
(ii)
				  January 1, 2025 - $ 401 (nursing home), $ 200 (home care - 50
				  percent);
(iii) January 1, 2026 - $
				  415 (nursing home), $ 207 (home care - 50 percent);
(iv) January 1, 2027 - $ 430 (nursing home),
				  $ 215 (home care - 50 percent);
(v)
				  January 1, 2028 - $ 445 (nursing home), $ 222 (home care - 50
				  percent);
(vi) January 1, 2029 - $
				  461 (nursing home), $ 230 (home care - 50 percent);
(vii) January 1, 2030 - $ 477 (nursing home),
				  $ 238 (home care - 50 percent);
(viii) January 1, 2031 - $ 494 (nursing
				  home), $ 247 (home care - 50 percent);
(ix) January 1, 2032 - $ 511 (nursing home),
				  $ 255 (home care - 50 percent);
(x)
				  January 1, 2033 - $ 529 (nursing home), $ 264 (home care - 50
				  percent).