Subdivision 1. Prohibited limitations. 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 by:
(1) requiring that the insured would need care in a skilled nursing facility if home health care services were not provided;
(2) requiring that the insured first or simultaneously receive nursing or therapeutic services in a home, community, or institutional setting before home health care services are covered;
(3) limiting eligible services to services provided by a registered nurse or licensed practical nurse;
(4) 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 licensure or certification;
(5) excluding coverage for personal care services provided by a home health aide;
(6) 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) requiring that the insured have an acute condition before home health care services are covered;
(8) limiting benefits to services provided by Medicare-certified agencies or providers;
(9) excluding coverage for adult day care services; or
(10) excluding coverage based upon location or type of residence in which the home health care services would be provided.
Subd. 2. Required coverage amount. A long-term care insurance policy or certificate, if it provides for home health or community care services, must 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 does not apply to policies or certificates issued to residents of continuing care retirement communities.
Subd. 3. Application of home health care coverage. 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.
1997 c 71 art 1 s 22; 1Sp2003 c 14 art 2 s 5
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62S — Qualified Long-term Care Insurance Policies
Section 62S.02 — Qualified Long-term Care Insurance Policy.
Section 62S.021 — Long-term Care Insurance; Initial Filing.
Section 62S.03 — Extraterritorial Jurisdiction.
Section 62S.04 — Prohibitions.
Section 62S.05 — Preexisting Condition.
Section 62S.06 — Prior Hospitalization Or Institutionalization.
Section 62S.07 — Right To Return; Refund.
Section 62S.08 — Coverage Outline.
Section 62S.081 — Required Disclosure Of Rating Practices To Consumers.
Section 62S.09 — Certificate Requirements.
Section 62S.10 — Policy Summary.
Section 62S.11 — Monthly Report.
Section 62S.12 — Claim Denial.
Section 62S.13 — Incontestability Period.
Section 62S.14 — Renewability.
Section 62S.15 — Authorized Limitations And Exclusions.
Section 62S.16 — Extension Of Benefits.
Section 62S.17 — Continuation Or Conversion.
Section 62S.18 — Discontinuance And Replacement.
Section 62S.181 — Electronic Enrollment For Group Policies.
Section 62S.19 — Unintentional Lapse.
Section 62S.20 — Required Disclosure Provisions.
Section 62S.21 — Prohibition Against Postclaims Underwriting.
Section 62S.22 — Minimum Standards For Home Health And Community Care Benefits.
Section 62S.23 — Requirement To Offer Inflation Protection.
Section 62S.24 — Requirements For Application Forms And Replacement Coverage.
Section 62S.25 — Reporting Requirements.
Section 62S.251 — Reserve Standards.
Section 62S.265 — Premium Rate Schedule Increases.
Section 62S.266 — Nonforfeiture Benefit Requirement.
Section 62S.267 — Standards For Benefit Triggers.
Section 62S.27 — Filing Requirement.
Section 62S.28 — Filing Requirements For Advertising.
Section 62S.29 — Standards For Marketing.
Section 62S.291 — Availability Of New Services Or Providers.
Section 62S.292 — Right To Reduce Coverage And Lower Premiums.
Section 62S.31 — Requirement To Deliver Shopper's Guide.
Section 62S.312 — Consumer Protection Standards For Long-term Care Partnership Policies.