Ill. Admin. Code tit. 50, § 2012.70 - Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies
a) A long-term care insurance policy or
certificate may not, if it provides benefits for home health care or community
care services, limit or exclude benefits:
1)
By requiring that the insured/claimant would need skilled care in a skilled
nursing facility if home health care services were not provided;
2) By requiring that the insured/claimant
first or simultaneously receive nursing and/or therapeutic services in a home
or community or institutional setting before home health care services are
covered;
3) By limiting eligible
services to services provided by registered nurses or licensed practical
nurses;
4) 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;
5) By requiring that the insured/claimant
have an acute condition before home health care services are covered;
6) By excluding coverage for personal care
services provided by a home health aide;
7) 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;
8) By limiting benefits to services provided
by Medicare-certified agencies or providers;
9) By excluding coverage for adult day care
services.
b) 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.
c) 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
Amended at 32 Ill. Reg. 7600, effective May 5, 2008
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