Minimum Standards for Home Health Care Benefits in Long-Term Care Insurance

Minimum Standards for Home Health Care Benefits in Long-Term Care Insurance Policies A. A long-term care insurance policy or certificate may not, if it provides benefits for home health care services, limit or exclude benefits: 1. By requiring that the insured/claimant would need skilled care in a skilled nursing facility if home health care services not provided; 2. By requiring that the insured/claimant first or simultaneously receive nursing and/or therapeutic services in a home or community setting before home health care services are covered; 3. By limiting eligible services to services provided by registered nurses or licensed practical nurses; 4. By requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide, or other licensed or certified home care worker acting within the scope of his or her licensure or certification; 5. By requiring that the insured/claimant have an acute condition before home health care services are covered; 6. By limiting benefits to services provided by Medicare-certified agencies or providers. B. Home health care coverage may be applied to the non-home health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.