Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 35 - Long Term Care Insurance › Part 1 - Long Term Care Insurance (formerly Insurance Regulation 44) › Section 230-RICR-20-35-1.5 - Policy Definitions

Current through June 14, 2024
A. 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, except that, when and if the
				  U.S. Treasury Department may develop additional or different policy definitions
				  intended to satisfy the requirements of Section  7702B(b)   of the Internal
				  Revenue Code of 1986 (26
				  U.S.C. §
											7702B(b)), as
				  amended, such definitions may be used in policies and certificates intended to
				  be tax qualified, instead of and/or in addition to the following definitions:
1. "Activities of daily living" means at
				  least bathing, continence, dressing, eating, toileting and
				  transferring.
2. "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.
3. "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.
4.
				  "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.
5. "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.
6. "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).
7. "Dressing" means putting
				  on and taking off all items of clothing and any necessary braces, fasteners or
				  artificial limbs.
8. "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.
9. "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.
10. "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.
11. "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.
12. "Mental or
				  nervous disorder" shall not be defined to include more than neurosis,
				  psychoneurosis, psychopathy, psychosis, or mental or emotional disease or
				  disorder.
13. "Personal care" means
				  the provision of hands-on services to assist an individual with activities of
				  daily living.
14. "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.
15. "Toileting" means
				  getting to and from the toilet, getting on and off the toilet, and performing
				  associated personal hygiene.
16.
				  "Transferring" means moving into or out of a bed, chair or
				  wheelchair.