18 Del. Admin. Code § 1404-5.0
No long-term care insurance policy delivered or issued for delivery in this state shall use the terms set forth below, or terms of like or similar meaning, unless the terms are defined in the policy and the definitions satisfy the following requirements:
"Activities of daily living" means at least bathing, continence, dressing, eating, toileting and transferring.
"Acute Condition" means that the individual is medically unstable. Such an individual requires frequent monitoring by medical professionals, such as physicians and registered nurses, in order to maintain their health status.
"Adult day care" means a program for 6 or more individuals, of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who can benefit from care in a group setting outside the home.
"Bathing" means washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.
"Chronically ill" means any individual who has been certified by a Licensed Health Care Practitioner as being unable to perform, without substantial assistance from another individual, at least two activities of daily living for a period of at least 90 days; or who requires substantial supervision to protect such individual from threats to health and safety due to severe cognitive impairment.
"Cognitive impairment" means a deficiency in a person's short-term or long-term memory, orientation as to person, place, and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.
"Continence" means the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).
"Dressing" means putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.
"Eating" means feeding oneself by getting food into the body from a receptacle or by feeding tube or intravenously.
"Hands-on Assistance" means physical assistance without which the individual would not be able to perform the activity of daily living.
"Home health care services" means medical and nonmedical services provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.
"Medicare" means "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as then constituted or later amended," or "Title I, Part I of Public Law 89-97, as enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," or words of similar import.
"Mental or nervous disorder" shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.
"Personal care" means the provision of hands-on services to assist an individual with activities of daily living (such as bathing, eating, dressing, transferring and toileting).
"Preexisting Conditions" shall be defined in accordance with 18 Del.C. § 7105 (c).
"Qualified Long-Term Care Insurance Policy" means a policy that provides coverage for qualified long-term care services that is intended to meet the requirements of Section 7702B(b) of the Internal Revenue Code of 1986, as amended.
"Qualified Long-Term Care Services" means necessary diagnostic, preventive therapeutic, curing, treating, mitigating and rehabilitative services and Maintenance or Personal Care Services which are required by a Chronically Ill Individual and are provided pursuant to a Plan of Care prescribed by a Licensed Health Care Practitioner.
"Skilled nursing care", "intermediate care", "personal care", "home care", and other services shall be defined in relation to the level of skill required, nature of the care and the setting in which care must be delivered.
"Toileting" means getting to and from the toilet, getting on and off the toilet, and performing associated functions.
"Transferring" means moving into or out of a bed, chair, or wheelchair.
All providers of services, including but not limited to "skilled nursing facility", "extended care facility", "intermediate care facility", "convalescent nursing home", "personal care facility", and "home care agency" shall be defined in relation to the services and facilities required to be available and the licensure or degree status of those providing or supervising the services. The definition may require that the provider be appropriately licensed or certified.
18 Del. Admin. Code § 1404-5.0
14 DE Reg. 316 (10/01/10)
25 DE Reg. 714 (1/1/2022)
26 DE Reg. 767 (3/1/2023) (Final)