Sec. 31.14.01.03. Policy Terms

A. A long-term care policy shall define "skilled nursing care", "intermediate care", "domiciliary care", "custodial care", "personal care", "home care", "specialized care", "assisted living care", and other services in relation to the level of skill required, the nature of the care, and the setting in which care shall be delivered.

B. Definitions in Contracts Regarding Providers of Services.

(1) A long-term care insurance policy shall define all providers of services, including, but not limited to, "skilled nursing facility", "extended care facility", "convalescent nursing home", "personal care facility", "specialized care providers", "assisted living facility", and "home care agency" in relation to the services and facilities required to be available and the licensure, certification, registration, or degree status of those providing or supervising the services.

(2) When the definition of a type of provider requires that the provider be appropriately licensed, certified, or registered, the definition shall also state what requirements a provider must meet instead of licensure, certification, or registration when the state in which the service is to be furnished:

(a) Does not require a provider of these services to be licensed, certified or registered; or

(b) Licenses, certifies, or registers the provider of services under another name.

C. A long-term care insurance policy may not use any of the terms defined in Regulation .02 of this chapter in a manner which is less favorable to the policyholder, the certificate holder, or the covered person.