California Insurance Code

§ 10232.8

INS § 10232.8 Effective Jan 1, 2019Div. 2 · Part 2 · Ch. 2.6 · Art. 3

Statute text

(a)In every long-term care policy or certificate that is not intended to be a federally qualified long-term care insurance contract and provides home care benefits, the threshold establishing eligibility for home care benefits shall be at least as permissive as a provision that the insured will qualify if either one of two criteria are met:

(1)Impairment in two out of seven activities of daily living.

(2)Impairment of cognitive ability. The policy or certificate may provide for lesser but not greater eligibility criteria. The commissioner, at his or her discretion, may approve other criteria or combinations of criteria to be substituted, if the insurer demonstrates that the interest of the insured is better served. “Activities of daily living” in every policy or certificate that is not intended to be a federally qualified long-term care insurance contract and provides home care benefits shall include eating, bathing, dressing, ambulating, transferring, toileting, and continence; “impairment” means that the insured needs human assistance, or needs continual substantial supervision; and “impairment of cognitive ability” means deterioration or loss of intellectual capacity due to organic mental disease, including Alzheimer’s disease or related illnesses, that requires continual supervision to protect oneself or others.

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Legislative history

Amended by Stats. 2018, Ch. 98, Sec. 3. (AB 2180) Effective January 1, 2019.