§ 31A-22-2002 — Definitions.

As used in this part:
(1) "Applicant" means:
(1)(a) when referring to an individual limited long-term care insurance policy, the person who seeks to contract for benefits; and
(1)(b) when referring to a group limited long-term care insurance policy, the proposed certificate holder.
(2) "Elimination period" means the length of time between meeting the eligibility for benefit payment and receiving benefit payments from an insurer.
(3) "Group limited long-term care insurance" means a limited long-term care insurance policy that is delivered or issued for delivery:
(3)(a) in this state; and
(3)(b) to an eligible group, as described under Subsection 31A-22-701(1).
(4) (4)(a) "Limited long-term care insurance" means an insurance policy, endorsement, or rider that is advertised, marketed, offered, or designed to provide coverage:
(4)(a)(i) for less than 12 consecutive months for each covered person;
(4)(a)(ii) on an expense-incurred, indemnity, prepaid or other basis; and
(4)(a)(iii) for one or more necessary or medically necessary diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care services that is provided in a setting other than an acute care unit of a hospital.
(4)(b) "Limited long-term care insurance" includes a policy or rider described in Subsection (4)(a) that provides for payment of benefits based on cognitive impairment or the loss of functional capacity.
(4)(c) "Limited long-term care insurance" does not include an insurance policy that is offered primarily to provide:
(4)(c)(i) basic Medicare supplement insurance coverage;
(4)(c)(ii) basic hospital expense coverage;
(4)(c)(iii) basic medical-surgical expense coverage;
(4)(c)(iv) hospital confinement indemnity coverage;
(4)(c)(v) major medical expense coverage;
(4)(c)(vi) disability income or related asset-protection coverage;
(4)(c)(vii) accidental only coverage;
(4)(c)(viii) specified disease or specified accident coverage; or
(4)(c)(ix) limited benefit health coverage.
(5) "Preexisting condition" means a condition for which medical advice or treatment is recommended:
(5)(a) by, or received from, a provider of health care services; and
(5)(b) within six months before the day on which the coverage of an insured person becomes effective.
(6) "Waiting period" means the time an insured waits before some or all of the insured's coverage becomes effective.

Legislative History

Amended by Chapter 120, 2024 General Session