Section 69O-157.119 - Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts(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.(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 627.9404(4), F.S.2. Certifications regarding activities of daily living and cognitive impairment shall be performed by a licensed health care practitioner as defined by Section 627.9404(6), F.S.(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least 90 days due to a loss of functional capacity and the insured is in claim status, the certification shall not be rescinded and additional certifications shall not be performed until after the expiration of the 90 day period.(3) Qualified long-term care insurance contracts shall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.Fla. Admin. Code Ann. R. 69O-157.119
Rulemaking Authority 624.308(1), 627.9407(1), 627.9408 FS. Law Implemented 624.307(1), 627.9402, 627.9407(1), 627.94074 FS.
New 1-13-03, Formerly 4-157.119.New 1-13-03, Formerly 4-157.119.