Texas § IN.1651.003 - LONG-TERM CARE BENEFIT PLAN DEFINED

§ IN.1651.003. LONG-TERM CARE BENEFIT PLAN DEFINED

LONG-TERM CARE BENEFIT PLAN DEFINED. (a) In this chapter, "long-term care benefit plan" means an insurance policy or group certificate, or rider to the policy or certificate, or evidence of coverage issued by a health maintenance organization subject to Chapter 843 , that is advertised or marketed as providing, or offered or designed to provide, coverage for not less than 12 consecutive months for each covered individual on an expense-incurred, indemnity, prepaid, or other basis for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital. (b) The term includes a plan or rider, other than a group or individual annuity or life insurance policy, that provides for payment of benefits based on cognitive impairment or the loss of functional capacity. (c) The term does not include an insurance policy, group certificate, or evidence of coverage that is offered primarily to provide: (1) basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident-only coverage, specified disease or specified accident coverage, or limited benefit health coverage; or (2) basic or single health care services. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.