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Current as of January 01, 2025 | Updated by Findlaw Staff
1. Prohibited provisions. A long-term care policy may not:
A. Contain coverage for skilled nursing facilities only;
B. Exclude coverage for skilled, intermediate or custodial care received by a resident of a skilled nursing or intermediate care facility;
C. Require a prior hospital stay as a condition for any policy benefits;
D. Require a prior skilled nursing facility stay as a condition for intermediate care facility benefits; or
E. Require prior institutionalization as a condition of receipt of home health care benefits.
2. Required provisions. A long-term care policy must provide:
A. Custodial care benefits that are at least 50% of those provided for skilled nursing care in a nursing facility provided that the benefits need not exceed usual, customary and reasonable charges;
B. Benefits for home health care services rendered by a home health care provider;
C. Home health care coverage for at least 90 visits in any continuous 12-month period during which coverage is in force; and
D. Per visit benefits for home health care services which are at least 50% of the daily benefit for skilled nursing facility confinement provided that the benefit need not exceed usual, customary and reasonable charges.
Cite this article: FindLaw.com - Maine Revised Statutes Title 24-A. Maine Insurance Code § 5051-A. Required and prohibited provisions - last updated January 01, 2025 | https://codes.findlaw.com/me/title-24-a-maine-insurance-code/me-rev-st-tit-24-a-sect-5051-a/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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