California Insurance Code

§ 10232.92

INS § 10232.92 Effective Jan 1, 2000Div. 2 · Part 2 · Ch. 2.6 · Art. 3

Statute text

Every long-term care policy or certificate covering confinement in a nursing facility shall also include a provision with the following features:

(a)Care in a residential care facility must be covered. “Residential care facility” means a facility licensed as a residential care facility for the elderly or a residential care facility as defined in the Health and Safety Code. Outside California, eligible providers are facilities that meet applicable licensure standards, if any, and are engaged primarily in providing ongoing care and related services sufficient to support needs resulting from impairment in activities of daily living or impairment in cognitive ability and which also provide care and services on a 24-hour basis, have a trained and ready-to-respond employee on duty in the facility at all times to provide care and services, provide three meals a day and accommodate special dietary needs, have agreements to ensure that residents receive the medical care services of a physician or nurse in case of emergency, and, have appropriate methods and procedures to provide necessary assistance to residents in the management of prescribed medications.

(b)The benefit amount payable for care in a residential care facility shall be no less than 70 percent of the benefit amount payable for institutional confinement.

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Legislative history

Repealed and added by Stats. 1999, Ch. 947, Sec. 6. Effective January 1, 2000.