§ 10-19-109 — Requirements for prior hospitalization or institutionalization

(1)
A long-term care insurance policy shall not be delivered or issued for delivery in
this state if such policy:

(a) Conditions the eligibility for any benefits on a prior hospitalization
requirement;

(b) Conditions the eligibility for benefits provided in an institutional care
setting on the receipt of a higher level of institutional care; or

(c) Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization
requirement.

(2) (a) A long-term care insurance policy containing any limitations or
conditions on eligibility for post-confinement, post-acute care, or recuperative
benefits shall clearly label in a separate paragraph of the policy or certificate
entitled Limitations or Conditions on Eligibility for Benefits such limitations or
conditions, including any required number of days of confinement.

(b) Effective July 1, 1991, a long-term care insurance policy containing a
benefit advertised, marketed, or offered as a home health care or home care benefit
shall not condition receipt of benefits on a prior institutionalization requirement.

(c) A long-term care insurance policy that conditions eligibility for
noninstitutional benefits on the prior receipt of institutional care shall not require a
prior institutional stay of more than thirty days.

(3) A long-term care insurance policy which provides benefits only following
institutionalization shall not condition such benefits upon admission to a facility for
the same or related conditions within a period of less than thirty days after
discharge from the institution.

Legislative History

Source: L. 90: Entire article R&RE, p. 647, � 1, effective July 1. L. 2007: (1), (2)(a), and (2)(c) amended, p. 199. � 5, effective January 1, 2008.