{"data":{"id":"us-nc/n.c.-gen.-stat.-58-55-35","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 58-55-35","heading":"Facilities, services, and conditions defined.","body":"(a)\tWhenever long-term care insurance provides coverage for the facilities, services, or physical or mental conditions listed below, unless otherwise defined in the policy and certificate, and approved by the Commissioner, the facilities, services, or conditions have the following definitions:\n(1)\tAdult care home. - As defined in G.S. 131D-2.1(3).\n(1a)\tAdult day care program. - As defined in G.S. 131D-6(b).\n(2)\tChore services. - Include the performance of tasks incidental to activities of daily living that do not require the services of a trained homemaker or other specialist. The services are provided to enable individuals to remain in their own homes and may include such services as: assistance in meeting basic care needs such as meal preparation; shopping for food and other necessities; running necessary errands; providing transportation to essential service facilities; care and cleaning of the house, grounds, clothing, and linens.\n(3)\tCombination home. - As defined in G.S. 131E-101(1a).\n(4)\tRepealed by Session Laws 1995, c. 535, s. 3.\n(5)\tFamily care home. - As defined in G.S. 131D-2.1(9).\n(6)\tRenumbered.\n(7)\tRepealed by Session Laws 1995, c. 535, s. 3.\n(8)\tHome care services. - As defined in G.S. 131E-136(3).\n(9)\tHomemaker services. - Supportive services provided by qualified para-professionals who are trained, equipped, assigned, and supervised by professionals within the agency to help maintain, strengthen, and safeguard the care of the elderly in their own homes. These standards must, at a minimum, meet standards established by the North Carolina Division of Social Services and may include: providing assistance in management of household budgets; planning nutritious meals; purchasing and preparing foods; housekeeping duties; consumer education; and basic personal and health care.\n(10)\tHospice. - As defined in G.S. 131E-176(13a).\n(11)\tIntermediate care facility for individuals with intellectual disabilities. - As defined in G.S. 131E-176(14a).\n(12)\tNursing home. - As defined in G.S. 131E-101(6).\n(13)\tRespite care, institutional. - Provision of temporary support to the primary caregiver of the aged individual or individual with a disability by taking over the tasks of that person for a limited period of time. The insured receives care for the respite period in an institutional setting, such as a nursing home, family care home, rest home, or other appropriate setting.\n(14)\tRespite care, non-institutional. - Provision of temporary support to the primary caregiver of the aged individual or individual with a disability by taking over the tasks of that person for a limited period of time in the home of the insured or other appropriate community location.\n(15)\tSkilled nursing facility. - An institution licensed under applicable State laws and primarily engaged in providing to inpatients, under the supervision of a doctor and a registered professional nurse, skilled nursing care and related services on a 24-hour basis, and rehabilitative services.\n(16)\tSupervised living facility for adults with developmental disabilities. - A residential facility, as defined in G.S. 122C-3(14), that has two to nine adult residents with developmental disabilities.\n(b)\tWhenever long-term care insurance provides coverage for organic brain disorder syndrome, progressive dementing illness, or primary degenerative dementia, such phrases shall be interpreted to include Alzheimer's Disease. A clinical diagnosis of \"organic brain disorder syndrome,\" \"progressive dementing illness,\" or \"primary degenerative dementia\" must be accepted as evidence that such a condition exists in an insured if a pathological diagnosis cannot be made, the medical evidence substantially documents the diagnosis of the condition, and the insured received treatment for the condition.\n(c)\tAll long-term care insurance policies must be filed with and approved by the Commissioner before they can be used in this State and are subject to the provisions of Article 38 of this Chapter. (1987, c. 331, s. 1; 1989, c. 207, ss. 5, 6; 1991, c. 721, s. 85; 1995, c. 535, s. 3; 2001-209, s. 4; 2008-187, s. 38(a); 2009-462, s. 4(a); 2019-76, s. 13(a).)","path":["Chapter 58. Insurance.","Article 55. Long-Term Care Insurance.","Part 1. General Provisions."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-55-35.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:06:53Z","sha256":"d1be65901d1cd84dade10c99903c9f04b9e2f0820278ec962639fe644af14b94","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-58-55-31","next":"us-nc/n.c.-gen.-stat.-58-55-50"},"notice":"GroundRules: Original legal text. Not legal advice."}