NAC687B.080. Definition of terms in contracts.

A long-term care insurance contract delivered or issued for delivery in this State may not use the following terms unless the terms are defined in the long-term care insurance contract as follows:

     1. “Activities of daily living” must be defined as including, without limitation, bathing, continence, dressing, eating, toileting and transferring.

     2. “Acute condition” must be defined as a condition making a person medically unstable and requiring frequent monitoring of the person by providers of health care, including, but not limited to, physicians and registered nurses, in order to maintain his or her status of health.

     3. “Adult day care” must be defined as a program, for six or more persons, of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired, elderly or disabled adults who can benefit from care in a group setting outside the home.

     4. “Bathing” must be defined as washing oneself by sponge bath or in a tub or shower, including, without limitation, the task of getting into or out of the tub or shower.

     5. “Cognitive impairment” must be defined as a deficiency in:

     (a) The short or long-term memory of the person;

     (b) Orientation as to person, place and time;

     (c) Deductive or abstract reasoning; or

     (d) Judgment as it relates to safety awareness.

     6. “Continence” must be defined as:

     (a) The ability of a person to maintain control of bowel and bladder function; or

     (b) If a person is unable to maintain control of bowel or bladder function, the ability of a person to perform associated personal hygiene, including, without limitation, caring for a catheter or colostomy bag.

     7. “Dressing” must be defined as putting on and taking off all items of clothing, including, without limitation, any necessary braces, fasteners or artificial limbs.

     8. “Eating” must be defined as feeding oneself by getting food into the body, including, without limitation:

     (a) From a receptacle, including, without limitation, a plate, cup or table;

     (b) By feeding tube; or

     (c) Intravenously.

     9. “Hands-on assistance” must be defined as physical assistance without which the person would not be able to perform the activity of daily living.

     10. “Home health care services” must be defined as medical and nonmedical services provided to ill, disabled or infirm persons in their residences. Covered services may include the services of a homemaker, assistance with activities of daily living and respite care.

     11. “Medicare” must be defined as:

     (a) “The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended”;

     (b) “Title I, Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof,”; or

     (c) Any words of similar import.

     12. “Mental or nervous disorder” must not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or a mental or emotional disease or disorder.

     13. “Personal care” must be defined as the provision of hands-on services to assist a person with activities of daily living.

     14. “Provider of services,” including, without limitation, a “skilled nursing facility,” “extended care facility,” “intermediate care facility,” “convalescent nursing home,” “personal care facility,” “specialized care provider,” “assisted living facility” and “home care agency” must be defined in relation to the services and facilities required to be available and the level of the licenses, certificates, registrations or degrees required for persons providing or supervising the services. If the definition requires that the provider be appropriately licensed, certified or registered, the definition must also set forth the requirements a provider must meet in lieu of licensure, certification or registration when the state in which the service is to be furnished does not require a provider of such services to be licensed, certified or registered or when the state licenses, certifies or registers such a provider under another name.

     15. “Skilled nursing care,” “intermediate care,” “specialized care,” “assisted living care,” “home care” and any other care received must be defined in relation to the level of skill required, the nature of the care and the setting in which the care must be provided.

     16. “Toileting” must be defined as:

     (a) Getting to and from the toilet;

     (b) Getting on and off the toilet; and

     (c) Performing associated personal hygiene.

     17. “Transferring” must be defined as moving into or out of a bed, chair or wheelchair.

     (Added to NAC by Comm’r of Insurance, eff. 11-21-88; A 12-15-94; R121-07, 9-18-2008, eff. 10-1-2008; R028-10, 12-16-2010, eff. 10-1-2011)