Subdivision 1.Applicability.

The definitions in this section apply to sections 62A.46 to 62A.56.

Subd. 2.Long-term care policy.

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

“Long-term care policy” means an individual or group policy, certificate, subscriber contract, or other evidence of coverage that provides benefits for prescribed long-term care, including nursing facility services or home care services, or both nursing facility services and home care services, pursuant to the requirements of sections 62A.46 to 62A.56.

Sections 62A.46, 62A.48, and 62A.52 to 62A.56 do not apply to a long-term care policy issued to (a) an employer or employers or to the trustee of a fund established by an employer where only employees or retirees, and dependents of employees or retirees, are eligible for coverage or (b) to a labor union or similar employee organization. The associations exempted from the requirements of sections 62A.3099 to 62A.44 under 62A.31, subdivision 1, clause (c) shall not be subject to the provisions of sections 62A.46 to 62A.56 until July 1, 1988.

Subd. 3.Nursing facility.

“Nursing facility” means (1) a facility that is licensed as a nursing home under chapter 144A; (2) a facility that is both licensed as a boarding care home under sections 144.50 to 144.56 and certified as an intermediate care facility for purposes of the medical assistance program; and (3) in states other than Minnesota, a facility that meets licensing and certification standards comparable to those that apply to the facilities described in clauses (1) and (2).

Subd. 4.Home care services.

“Home care services” means one or more of the following prescribed services for the long-term care and treatment of an insured that are provided by a home health agency in a noninstitutional setting according to a written diagnosis or assessment and plan of care:

(1) nursing and related personal care services under the direction of a registered nurse, including the services of a home health aide;

(2) physical therapy;

(3) speech therapy;

(4) respiratory therapy;

(5) occupational therapy;

(6) nutritional services provided by a licensed dietitian;

(7) homemaker services, meal preparation, and similar nonmedical services;

(8) medical social services; and

(9) other similar medical services and health-related support services.

Subd. 5.Prescribed long-term care.

“Prescribed long-term care” means a service, type of care, or procedure that could not be omitted without adversely affecting the patient’s illness or condition and is specified in a plan of care prepared by either: (1) a physician and a registered nurse and is appropriate and consistent with the diagnosis; or (2) a registered nurse or licensed social worker based on an assessment of the insured’s ability to perform the activities of daily living and to perform basic cognitive functions appropriately.

Subd. 6.Qualified insurer.

“Qualified insurer” means an entity licensed under chapter 62A or 62C.

Subd. 7.Physician.

“Physician” means a medical practitioner licensed or holding a temporary permit under sections 147.02, 147.03, 147.037, or holding a residency permit under section 147.0391.

Subd. 8.Plan of care.

“Plan of care” means a written document prepared and signed by either: (1) a physician and registered nurse that specifies medically prescribed long-term care services or treatment that are consistent with the diagnosis; or (2) by a registered nurse or licensed social worker that specifies prescribed long-term care services or treatment that are consistent with an assessment of the insured’s ability to perform the activities of daily living and to perform basic cognitive functions appropriately. The plan of care must be prepared in accordance with accepted standards of practice and must contain services or treatment that could not be omitted without adversely affecting the patient’s illness or condition.

Subd. 9.Insured.

“Insured” means a person covered under a long-term care policy.

Subd. 10.Home health agency.

“Home health agency” means an entity that provides home care services and is (1) certified for participation in the Medicare program; or (2) licensed as a home health agency where a state licensing statute exists, or is otherwise acceptable to the insurer if licensing is not required.

Subd. 11.Benefit period.

“Benefit period” means one or more separate or combined periods of confinement covered by a long-term care policy in a nursing facility or at home while receiving home care services. A benefit period begins on the first day the insured receives a benefit under the policy and ends when the insured has received no benefits for the same or related cause for an interval of 180 consecutive days.

Subd. 12.Homebound or house confined.

“Homebound or house confined” means that a person is physically unable to leave the home without another person’s aid because the person has lost the capacity of independent transportation or is disoriented.

Subd. 13.Benefit day.

“Benefit day” means each day of confinement in a nursing facility or each visit for home care services. For purposes of section 62A.48, subdivision 1, if the policyholder receives more than one home care service visit within a 24-hour period, each visit constitutes one benefit day.