Subdivision 1. Benefit payment determinations. A long-term care insurance policy must condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits must not be more restrictive than requiring either a deficiency in the ability to perform not more than two of the activities of daily living or the presence of cognitive impairment.
Activities of daily living include at least the following as defined in section 62S.01 and in the policy: bathing, continence, dressing, eating, toileting, and transferring.
Insurers may use activities of daily living to trigger covered benefits in addition to those contained in this subdivision as long as they are defined in the policy.
Subd. 2. Additional provisions for determining benefit payments. An insurer may use additional provisions for the determination of when benefits are payable under a policy or certificate if the provisions do not restrict, and are not in lieu of, the requirements contained in subdivision 1.
Subd. 3. Deficiency determination. For purposes of this section, the determination of a deficiency must not be more restrictive than requiring the hands-on assistance of another person to perform the prescribed activities of daily living, or if the deficiency is due to the presence of a cognitive impairment, supervision or verbal cueing by another person is needed in order to protect the insured or others.
Subd. 4. Assessments. Assessments of activities if daily living and cognitive impairment must be performed by licensed or certified professionals, such as physicians, nurses, or social workers.
Subd. 5. Appeal process. Long-term care insurance policies must include a clear description of the process for appealing and resolving benefit determinations.
2008 c 344 s 34
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.