§8085. Minimum benefits and coverage; general

Link to law: http://legislature.vermont.gov/statutes/section/08/154/08085
Published: 2015

Print

The Vermont Statutes Online



Title

08

:
Banking and Insurance






Chapter

154

:
LONG-TERM CARE INSURANCE











 

§

8085. Minimum benefits and coverage; general

(a) The

Commissioner shall adopt rules establishing standards for minimum benefits and

coverage that must be provided by a long-term care insurance policy to carry

out the purposes of subsection (b) of this section. Nothing in this section

prohibits an insurer from underwriting in accordance with that insurer's

underwriting standards and the requirements of section 8086 of this title.

(b) No long-term

care insurance policy may:

(1) be

cancelled, nonrenewed, or otherwise terminated on grounds other than by

cancellation by the insured individual or certificate holder; nonpayment of

premiums by the insured individual or certificate holder; all amounts

potentially payable under the terms of the policy having been fully paid out;

or except as provided for in section 8094 of this title;

(2) contain a

provision establishing a new waiting period in the event existing coverage is

converted to or replaced by a new or other form within the same company, except

with respect to an increase in benefits voluntarily selected by the insured

individual or group policyholder;

(3) provide

coverage for skilled nursing care only or provide significantly more coverage

for skilled care in a facility than coverage for lower levels of care;

(4) deny

benefits or coverage on the basis that the need for services arises from a

mental condition or Alzheimer's disease and related disorders;

(5) be issued

without including a provision covering home health care benefits that complies

with the standards for minimum benefits and coverage established by rule under

subsection (a) of this section;

(6) fail to

offer adult day care benefits, either in the policy or as an optional rider,

that comply with the standards for minimum benefits and coverage established by

rule under subsection (a) of this section;

(7) be offered

without including an option for inflation adjustment protection that complies

with the standards for minimum benefits and coverage established by rule under

subsection (a) of this section;

(8) include a

deductible or elimination period in excess of 100 days, computed in a manner

prescribed by the Commissioner by rule, for any covered benefit;

(9) require

payment of premiums more frequently than monthly; or

(10) be

represented as having a premium described as level, fixed, or by similar words,

if the premium is not, in fact, fixed and may be increased. (Added 2003, No.

124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended 2013, No. 96 (Adj. Sess.), §

23.)
Read Entire Law on legislature.vermont.gov