Oregon Statutes - Chapter 743 - Health and Life Insurance - Section 743.656 - Eligibility for benefits; providers required to be covered.

(1) No long term care insurance policy shall be delivered or issued for delivery in this state unless the policy determines eligibility for benefits through a determination that is not more restrictive than requiring that:

(a) The policyholder be functionally impaired and needing assistance in any three or more activities of daily living as defined by the Director of the Department of Consumer and Business Services, by rule, after consultation with the Director of Human Services.

(b) Benefits must be payable when the beneficiary is receiving covered services from any of the following providers approved by the insurer:

(A) Nursing home;

(B) Assisted living;

(C) Home care; and

(D) Adult foster care.

(c) The insurer shall approve nursing home, assisted living, home care, adult foster home and any other providers of covered services by using standards that have been submitted to and approved by the director in consultation with the Director of Human Services.

(2) No long term care policy that offers only nursing home benefits shall be sold in this state. [1989 c.1022 §§13,14; 2003 c.14 §449]

Section:  Previous  743.648  743.650  743.651  743.652  743.653  743.654  743.655  743.656  743.657  743.660  743.662  743.663  743.664  743.666  743.669  Next

Last modified: August 7, 2008