§ 58010. Elimination Period.

“Elimination Period” is defined as either (a) or (b).

(a) “Elimination Period” means the total number of days that covered, Formal Long-Term Care Services must be received after the insured is determined to be a Chronically Ill Individual and before the benefits covered by the Policy or Certificate are payable. The number of days must be accumulated within a nine-month period [insurer option: a period longer than 9 months, but not shorter than 9 months can be used] after the insured has been determined to be a Chronically Ill Individual. The number of days can be accumulated before the filing of a claim if the insured can establish that he or she was a Chronically Ill Individual before filing a claim. The Elimination Period need only be met once during a lifetime. Any day when covered services [insurer option: days the insured receives inpatient care in a general acute care hospital may also be counted] are reimbursed by other insurance or Medicare may be counted toward meeting the Elimination Period. Respite Care [insurer option: list other benefits that are exempted] is not subject to the Elimination Period.

(b) “Elimination Period” means a provision that defines the number of days the insured must be disabled before the benefits covered by the Policy or Certificate are payable, and that is approved by the Department of Health Services.

HISTORY

1. New section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36). Submitted for printing only pursuant to section 22009, Welfare and Institutions Code.

2. Certificate of Compliance as to 8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).

3. Repealer of former section 58010 and renumbering and amendment of former section 58014 to new section 58010 filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 22009(d) (Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-29-99 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 10-1-98 order transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No. 12).

5. Amendment of section and Note filed 5-30-2001 as an emergency; operative 5-30-2001. A Certificate of Compliance must be transmitted to OAL by 9-27-2001 or emergency language will be repealed by operation of law on the following day. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 22009(d) (Register 2001, No. 22).

6. Certificate of Compliance as to 5-30-2001 order transmitted to OAL 9-24-2001 and filed 10-31-2001 (Register 2001, No. 44).

Note

Note: Authority cited: Section 22009(a), Welfare and Institutions Code. Reference: Section 22005.1(b), Welfare and Institutions Code.