24-A M.R.S. §5051-A: Required and prohibited provisions

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.