Definitions.

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  • (1) "Applicant" means:
    • (a) when referring to an individual limited long-term care insurance policy, the person who seeks to contract for benefits; and
    • (b) when referring to a group limited long-term care insurance policy, the proposed certificate holder.
  • (2) "Elimination period" means the length of time between meeting the eligibility for benefit payment and receiving benefit payments from an insurer.
  • (3) "Group limited long-term care insurance" means a limited long-term care insurance policy that is delivered or issued for delivery:
    • (a) in this state; and
    • (b) to an eligible group, as described under Subsection 31A-22-701(2).
  • (4)
    • (a) "Limited long-term care insurance" means an insurance policy, endorsement, or rider that is advertised, marketed, offered, or designed to provide coverage:
      • (i) for less than 12 consecutive months for each covered person;
      • (ii) on an expense-incurred, indemnity, prepaid or other basis; and
      • (iii) for one or more necessary or medically necessary diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care services that is provided in a setting other than an acute care unit of a hospital.
    • (b) "Limited long-term care insurance" includes a policy or rider described in Subsection (4)(a) that provides for payment of benefits based on cognitive impairment or the loss of functional capacity.
    • (c) "Limited long-term care insurance" does not include an insurance policy that is offered primarily to provide:
      • (i) basic Medicare supplement coverage;
      • (ii) basic hospital expense coverage;
      • (iii) basic medical-surgical expense coverage;
      • (iv) hospital confinement indemnity coverage;
      • (v) major medical expense coverage;
      • (vi) disability income or related asset-protection coverage;
      • (vii) accidental only coverage;
      • (viii) specified disease or specified accident coverage; or
      • (ix) limited benefit health coverage.
  • (5) "Preexisting condition" means a condition for which medical advice or treatment is recommended:
    • (a) by, or received from, a provider of health care services; and
    • (b) within six months before the day on which the coverage of an insured person becomes effective.
  • (6) "Waiting period" means the time an insured waits before some or all of the insured's coverage becomes effective.




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