Ga. Comp. R. & Regs. R. 120-2-16-.12 - Minimum Standards for Home Health and Community Care Benefits in Long - Term Care Insurance Policies
(1) A long-term care insurance policy or
certificate shall not, if it provides benefits for home health care or
community care services limit or exclude benefits:
(a) By requiring that the insured or claimant
would need care in a skilled nursing facility if home health care services were
not provided;
(b) By requiring that
the insured or claimant first or simultaneously receive nursing or therapeutic
services, or both, in a home, community or institutional setting before home
health care services are covered;
(c) By limiting eligible services to services
provided by registered nurses or licensed practical nurses;
(d) By requiring that a nurse or therapist
provide services covered by the policy that can be provided by a home health
aide, or other licensed or certified home care worker acting within the scope
of his or her licensure or certification;
(e) By excluding coverage for personal care
services provided by a home health aide;
(f) By requiring that the provision of home
health care services be at a level of certification or licensure greater than
that required by the eligible service;
(g) By requiring that the insured or claimant
have an acute condition before home health care services are covered;
(h) By limiting benefits to services provided
by Medicare-certified agencies or providers; or
(i) By excluding coverage for adult day care
services.
(2) A
long-term care insurance policy or certificate, if it provides for home health
or community care services, shall provide total home health or community care
coverage that is a dollar amount equivalent to at least one-half of one year's
coverage available for nursing home benefits under the policy or certificate,
at the time covered home health or community care services are being received.
This requirement shall not apply to policies or certificates issued to
residents of continuing care retirement communities.
(3) Home health care coverage may be applied
to the nonhome health care benefits provided in the policy or certificate when
determining maximum coverage under the terms of the policy or
certificate.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.