Cal. Code Regs. Tit. 22, § 58062 - Benefits and Provisions Allowable in Partnership Policies or Certificates
Issuers are allowed to include the following optional benefits and provisions in Partnership Long-Term Care Policies and Certificates;
(a) additional benefits
over the minimum benefits required in Comprehensive Benefit Policies or
Certificates by Section
58059(e), so long
as these benefits are for Long-Term Care Services Countable Toward the Medi-Cal
Property Exemption.
(b) a provision
to prorate home and community-based care benefits based on the percentage of
the month a Policy or Certificate holder was eligible for benefits.
(c) a provision in expense reimbursable
Policies and Certificates that requires Policy or Certificate holders to pay
co-payments, not to exceed twenty percent (20%), toward the cost of any home
and community-based care benefits received in one day that exceed
$50.
(d) the use of a Preferred
Provider Organization (PPO) to deliver covered benefits and/or the use of a
Point-of-Service reimbursement schedule that provides different reimbursement
rates for Policy or Certificate holders who go out-of-plan to receive covered
benefits, provided that the reimbursement rates at least meet the minimum
benefits specified in Section
58050.
(e) a provision that institutional and home
and community-based care benefits need not be paid on the same day.
Notes
2. Certificate of Compliance as to 8-30-93 order, including amendment of subsection (d) transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of section heading, first paragraph and subsections (a) and (c), repealer of subsection (d) and subsection relettering filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 22009(d) (Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-29-99 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 10-1-98 order transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No. 12).
Note: Authority cited: Section 22009(a), Welfare and Institutions Code. Reference: Section 22005, Welfare and Institutions Code.
2. Certificate of Compliance as to 8-30-93 order, including amendment of subsection (d) transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of section heading, first paragraph and subsections (a) and (c), repealer of subsection (d) and subsection relettering filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 22009(d) (Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-29-99 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 10-1-98 order transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No. 12).
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