§ 58062. Benefits and Provisions Allowable in Partnership Policies or Certificates.

Issuers are allowed to include the following optional benefits and provisions in Partnership Long-Term Care Policies and Certificates;

(a) additional benefits over the minimum benefits required in Comprehensive Benefit Policies or Certificates by Section 58059(e), so long as these benefits are for Long-Term Care Services Countable Toward the Medi-Cal Property Exemption.

(b) a provision to prorate home and community-based care benefits based on the percentage of the month a Policy or Certificate holder was eligible for benefits.

(c) a provision in expense reimbursable Policies and Certificates that requires Policy or Certificate holders to pay co-payments, not to exceed twenty percent (20%), toward the cost of any home and community-based care benefits received in one day that exceed $50.

(d) the use of a Preferred Provider Organization (PPO) to deliver covered benefits and/or the use of a Point-of-Service reimbursement schedule that provides different reimbursement rates for Policy or Certificate holders who go out-of-plan to receive covered benefits, provided that the reimbursement rates at least meet the minimum benefits specified in Section 58050.

(e) a provision that institutional and home and community-based care benefits need not be paid on the same day.

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, including amendment of subsection (d) transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).

3. Amendment of section heading, first paragraph and subsections (a) and (c), repealer of subsection (d) and subsection relettering 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 A Certificate of Compliance must be transmitted to OAL by 1-29-99 or emergency language will be repealed by operation of law on the following day.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).

Note

Note: Authority cited: Section 22009(a), Welfare and Institutions Code. Reference: Section 22005, Welfare and Institutions Code.