33-22-1125. Benefit triggers. (1) A long-term care insurance policy or certificate may not be delivered or issued for delivery in this state unless it complies with the requirements, as established by rules of the commissioner, for the triggering of mandatory provision of benefits.
     (2) A qualified long-term care insurance contract must condition the payment of benefits on a determination of the insured's inability to perform activities of daily living for an expectation of at least 90 days because of a loss of level of disability described under regulations adopted by the U.S. secretary of the treasury and because of:
     (a) a loss of functional capacity requiring the substantial assistance of another person to perform the prescribed activities of daily living; or
     (b) a severe cognitive impairment requiring substantial supervision, including verbal cueing, by another person to protect the insured from harming the insured or others for from threats to the insured's health or safety.
     (3) An insured meets a condition of payment if, within the preceding 12-month period, a licensed health care practitioner has certified that the insured has met the requirements and the practitioner has prescribed the qualified long-term care insurance services pursuant to a plan of care. Eligibility for the payment of benefits may not be more restrictive than requiring a deficiency in the ability to perform not more than three of the activities of daily living.

     History: En. Sec. 49, Ch. 416, L. 1997.