§ 10-19-109. Requirements for Prior Hospitalization or Institutionalization

1. A long-term care insurance policy shall not be delivered or issued for delivery in this state if such policy:
   1. Conditions the eligibility for any benefits on a prior hospitalization requirement;
   2. Conditions the eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
   3. Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization requirement.
2. 1. A long-term care insurance policy containing any limitations or conditions on eligibility for post-confinement, post-acute care, or recuperative benefits shall clearly label in a separate paragraph of the policy or certificate entitled “Limitations or Conditions on Eligibility for Benefits” such limitations or conditions, including any required number of days of confinement.
   2. Effective July 1, 1991, a long-term care insurance policy containing a benefit advertised, marketed, or offered as a home health care or home care benefit shall not condition receipt of benefits on a prior institutionalization requirement.
   3. A long-term care insurance policy that conditions eligibility for noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty days.
3. A long-term care insurance policy which provides benefits only following institutionalization shall not condition such benefits upon admission to a facility for the same or related conditions within a period of less than thirty days after discharge from the institution.

Source: L. 90: Entire article R&RE, p. 647, § 1, effective July 1. L. 2007: (1), (2)(a), and (2)(c) amended, p. 199. § 5, effective January 1, 2008.