§ 31A-22-1407. Restricted conditional terms.

(1) A long-term care insurance policy may not contain a provision that conditions eligibility:

(a) for any benefits on a prior hospitalization requirement;

(b) for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or

(c) for any benefits on a prior institutionalization requirement except for eligibility for:

(i) waiver of premium;

(ii) post confinement;

(iii) post-acute care; or

(iv) recuperative benefits.

(2) A long-term care insurance policy containing post confinement, post-acute care, or recuperative benefits shall clearly label the limitations or conditions, including any required number of days of confinement in a separate paragraph of the policy or certificate that is entitled "Limitations or Conditions on Eligibility for Benefits."

(3) A long-term care insurance policy or rider that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days.

Amended by Chapter 116, 2001 General Session