NAC687B.0825. Activities of daily living and cognitive impairment to be used to measure needs of insured and to be described in contract or certificate; benefit triggers.

     1. Activities of daily living and cognitive impairment must be used to measure the needs of an insured for long-term care and must be described in a long-term care insurance contract or certificate in a separate paragraph that must be labeled as “Eligibility for the Payment of Benefits.” Any additional benefit triggers must also be explained and must include, without limitation, whether:

     (a) Any such benefit triggers differ for different benefits; and

     (b) An attending physician or other specified person is required to certify a certain level of functional dependency for the insured to be eligible for benefits.

     2. The description of any benefit in a long-term care insurance contract or certificate must include an explanation of the benefit trigger.

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