N.Y. Insurance Law § 3229: Minimum benefit standards for certain long term care plans

§ 3229. Minimum benefit standards for certain long term care plans.

(a) The minimum standards for an insurance plan, which may qualify under

the partnership for long term care program pursuant to section three

hundred sixty-seven-f of the social services law, shall be established

by regulations of the superintendent, in consultation with the

commissioner of health and the director of the state office for the

aging, as approved by the director of the budget, which shall require at

a minimum (1) a residential health care facility benefit in an amount to

be determined by the regulations of the superintendent; (2) a home care

benefit with personal care, nursing care, adult day health care and

respite care services, which shall provide total benefits in an amount

determined by regulations of the superintendent; (3) a duration of

benefits not less than twelve months; and (4) arrangements through the

insurance plan for managed care including preauthorized assessment and

referral programs, utilization controls and use of approved providers.

(b) In establishing minimum benefit standards for insurance plans

pursuant to this section, the superintendent shall seek to ensure the

cost effectiveness of the partnership for long term care program

established pursuant to section three hundred sixty-seven-f of the

social services law, and may establish minimum permissible payments

under such insurance plans. The superintendent shall not approve an

insurance plan which includes an exclusion for pre-existing conditions

that exceeds six months, or which does not comply with paragraph six of

subsection (b) of section one thousand one hundred seventeen of this

chapter.