Florida Regulations 69O-157.009: Minimum Coverage
Current as of: 2024 | Check for updates
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(1) All long-term care policies shall provide coverage for at least 24 consecutive months for each covered person for care in a nursing home.
(2) All long-term care policies shall provide coverage for at least one type of lower level of care in addition to coverage for care in a nursing home.
(3) No long-term care policy may provide significantly more coverage for care in a nursing home than coverage for lower levels of care. In furtherance of this requirement, benefits for all lower levels of care, in the aggregate, shall provide a level of benefits equivalent to 50 percent of the benefits provided for nursing home coverage. For the purposes of applying this 50 percent equivalency requirement, if a long-term care policy provides nursing home coverage for an unlimited duration, the nursing home benefit shall be considered to be payable for ten years. A long-term care policy may use an overall lifetime benefit maximum which may be exhausted by any combination of benefits.
(4) For the purposes of this rule, “”lower level(s) of care”” means the following:
(a) Nursing service;
(b) Adult congregate living facility;
(c) Home health agency;
(d) Adult day care center;
(e) Adult foster home;
(f) Community care for the elderly;
(g) Personal care and social services;
(h) Such other lower levels of care as approved by the Office.
Rulemaking Authority Florida Statutes § 624.308(1), 627.9407(1) FS. Law Implemented 624.307(1), 627.9407(1), (3) FS. History-New 5-17-89, Formerly 4-81.009, 4-157.009.
(2) All long-term care policies shall provide coverage for at least one type of lower level of care in addition to coverage for care in a nursing home.
(3) No long-term care policy may provide significantly more coverage for care in a nursing home than coverage for lower levels of care. In furtherance of this requirement, benefits for all lower levels of care, in the aggregate, shall provide a level of benefits equivalent to 50 percent of the benefits provided for nursing home coverage. For the purposes of applying this 50 percent equivalency requirement, if a long-term care policy provides nursing home coverage for an unlimited duration, the nursing home benefit shall be considered to be payable for ten years. A long-term care policy may use an overall lifetime benefit maximum which may be exhausted by any combination of benefits.
(4) For the purposes of this rule, “”lower level(s) of care”” means the following:
(a) Nursing service;
(b) Adult congregate living facility;
(c) Home health agency;
(d) Adult day care center;
(e) Adult foster home;
(f) Community care for the elderly;
(g) Personal care and social services;
(h) Such other lower levels of care as approved by the Office.
Rulemaking Authority Florida Statutes § 624.308(1), 627.9407(1) FS. Law Implemented 624.307(1), 627.9407(1), (3) FS. History-New 5-17-89, Formerly 4-81.009, 4-157.009.