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Florida Administrative Code (Last Updated: April 18, 2024) |
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69. Department of Financial Services |
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69O. OIR – Insurance Regulation |
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69O-157. Long-Term Care Insurance |
69O-157.119. Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts
1(1) A qualified long term care insurance contract shall pay only for qualified long term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by a licensed health care practitioner.
38(2)(a)1. A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured’s being chronically ill as defined in Section 64627.9404(4), F.S.
662. Certifications regarding activities of daily living and cognitive impairment shall be performed by a licensed health care practitioner as defined by Section 89627.9404(6), F.S.
91(b) When a licensed health care practitioner has certified that an insured is unable to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity and the insured is in claim status, the certification shall not be rescinded and additional certifications shall not be performed until after the expiration of the 90 day period.
156(3) Qualified long-term care insurance contracts shall include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.
180Specific Authority 182624.308(1), 183627.9407(1), 184627.9408 FS. 186Law Implemented 188624.307(1), 189627.9402, 190627.9407(1), 191627.94074 FS. 193History–New 1-13-03, Formerly 4-157.119.
