NAC687B.084. Requirements relating to qualified long-term care insurance contract.

     1. A qualified long-term care insurance contract must pay only for qualified long-term care services:

     (a) Received by a chronically ill individual; and

     (b) Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

     2. The payment of benefits under a qualified long-term care insurance contract must be conditioned on a certification of the inability of the insured to perform the activities of daily living for an expected period of at least 90 days because of a loss of functional capacity or severe cognitive impairment.

     3. Certifications pursuant to subsection 2 regarding activities of daily living and cognitive impairment:

     (a) Must be performed by a licensed health care practitioner.

     (b) May be performed by a licensed health care practitioner at the direction of the insurer as is reasonably necessary with respect to a specific claim, except that if 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90 days because of a loss of functional capacity and the insured is receiving benefits, the certification may not be rescinded and additional certifications must not be performed until after the expiration of the 90-day period.

     4. A qualified long-term care insurance contract must include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.

     5. As used in this section:

     (a) “Chronically ill individual” has the meaning ascribed to it in 26 U.S.C. § 7702B(c)(2).

     (b) “Licensed health care practitioner” means a person licensed pursuant to chapters 630 to 633, inclusive, of NRS, a licensed social worker or other individual who meets the requirements prescribed by the Secretary of the Treasury pursuant to 26 U.S.C. § 7702B(c)(4).

     (c) “Qualified long-term care services” has the meaning ascribed to it in 26 U.S.C. § 7702B(c)(1).

     (Added to NAC by Comm’r of Insurance by R121-07, 9-18-2008, eff. 10-1-2008)