SECTION 3.3825. Prior Hospitalization or Institutionalization

(a) No long-term care insurance policy or certificate may be delivered or issued for delivery in this state which conditions the eligibility for benefits on prior hospitalization.

(b) No long-term care insurance policy or certificate may be delivered or issued for delivery in this state if such policy conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care.

(c) No long-term care insurance policy or certificate may be delivered or issued for delivery in this state which conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization requirement.

(d) Any long-term care insurance policy or certificate containing post-confinement, post-acute care, or recuperative benefits, which are subject to any limitations or conditions for eligibility, including any required number of days of confinement, shall clearly label such limitations or conditions, including any required number of days of confinement, in a separate paragraph of the policy or certificate, entitled "Limitations or Conditions on Eligibility for Benefits."

(1) No long-term care insurance policy or certificate containing a benefit advertised, marketed, or offered as a home care or a home health care benefit may condition receipt of benefits on a prior institutionalization requirement.

(2) No long-term care insurance policy or certificate which conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall require a prior institutional stay of more than 30 days for which benefits are paid.

Source Note: The provisions of this §3.3825 adopted to be effective February 15, 1990, 15 TexReg 544; amended to be effective July 20, 1992, 17 TexReg 4769