Kansas Administrative Regulations

Agency 40.  Insurance Department

Article 4.  Accident and Health Insurance

 40-4-37e Long-term care insurance; prohibited policy provisions.

A long-term care policy shall not:

(a)  Contain an elimination period greater than 100 days for each period of confinement in a nursing home or for all confinements in a nursing home which are due to the same or related causes and separated from each other by less than six months;

(b)  exclude coverage for confinement to an intermediate nursing facility when benefits are provided for nursing care;

(c)  provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care;

(d)  be delivered or issued for delivery to any person in this state unless every printed portion of the text of the policy is plainly printed in not less than 10 point type;

(e)  require prior confinement to a hospital or prior confinement for a greater level of nursing care as a condition precedent to the payment of inpatient benefits;

(f)  be delivered in this state unless the following notice is attached to the policy:

“IMPORTANT NOTICE''

 

“Please read the copy of the application attached to this policy. Carefully check the application and write to the company  _____ (address) _____, within 30 days, if any information shown on it is not correct and complete, or if any past medical history has been left out of the application. This application is a part of the policy and the policy was issued on the basis that answers to all questions and the information shown on the application are correct and complete.''

This statement, preferably in the form of a sticker to be placed on the policy, shall be printed in a prominent manner on paper or in ink of a contrasting color. The insurer may, with the approval of the commissioner of insurance, substitute wording of similar import so long as equal results are obtained. This requirement shall not apply if the application for insurance is not attached to and made a part of the contract.

(g)  be cancelled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder;

(h)  if it provides benefits for home health care or community care services, limit or exclude benefits:

(1)  By requiring that the insured or claimant would need care in a skilled nursing facility if home health care services were not provided;

(2)  by requiring that the insured or claimant first or simultaneously receive nursing or therapeutic services in a home, 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 the home care worker's licensure or certification;

(5)  by excluding coverage for personal care services provided by a home health aide;

(6)  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;

(7)  by requiring that the insured or claimant have an acute condition before home health care services are covered;

(8)  by limiting benefits to services provided by medicare-certified agencies or providers; or

(9)  by excluding coverage for adult day care services.

 

(Authorized by K.S.A. 40-103, K.S.A. 1991 Supp. 40-2228; implementing K.S.A. 1991 Supp. 40-2228; effective Jan. 4, 1993.)