N.Y. Comp. Codes R. & Regs. tit. 11 § 52.13

Current through Register Vol. 46, No. 45, November 2, 2024

Section 52.13 - Nursing home insurance only, home care insurance only, or nursing home and home care insurance

(a) Nursing home and home care insurance is an insurance policy, rider, or certificate advertised, marketed, offered or designed to provide coverage, subject to eligibility requirements, for not less than 12 consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis and which provides at least the benefits set forth in paragraphs (1) and (2) of this subdivision:

(1) coverage of custodial care services of at least $50 a day while confined in a nursing home; and

(2) coverage of custodial care services of at least $25 per day in a private home.

(b) A nursing home insurance only policy or certificate or a home care insurance only policy or certificate meeting the minimum standards set forth in either paragraph (a)(1) or (2) of this section may be sold in this State, however, the insurer selling such a policy or certificate must offer a nursing home and home care insurance policy or certificate at the same time.

(c) No insurance policy or certificate covering custodial care in a nursing home or custodial home care services shall be sold in this State unless it meets or exceeds the minimum standards set forth in either paragraph (a)(1) or (2) of this section or meets or exceeds the minimum standards set forth in paragraphs (a)(1) and (2) of this section for a nursing home and home care insurance policy or certificate.

(d) A nursing home insurance only, home care insurance only, or nursing home and home care insurance policy or certificate may include coverage of all levels of care, however, the benefit levels for all services in the same setting must be the same.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.13