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§3229

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

§3229(a)

(a) The minimum standards for an insurance plan, which may qualify under the partnership for long term care program pursuant to §300 f the social services law, shall be established by regulations the superin10dent, in consultation with the commissi1r health the director the state office for the aging, as approved by the director the budget, which shall require at a minimum (1) a residential health care facility benefit in an amount to be determined by the regulations the superin10dent; (2) a home care benefit with personal care, nursing care, adult day health care respite care services, which shall provide total benefits in an amount determined by regulations the superin10dent; (3) a duration benefits not less than 12 months; and (4) arrangements through the insurance plan for managed care including preauthorized assessment and referral programs, utilization controls and use of approved providers.

§3229(b)

(b) In establishing minimum benefit standards for insurance plans pursuant to (this §) ,the superintendent shall seek to ensure the cost effectiveness of the partnership for long term care program established pursuant to §300 f the social services law, may establish minimum permissible payments under such insurance plans. The superin10dent shall not approve an insurance plan which includes an exclusion for pre-existing conditions that exceeds 6 months, or which does not comply with paragraph §1117(b)(6) of this chapter.
Source Data downloaded: 2009-04-19 12: 25: 15;       Processed: 2009-05-08 15: 36: 02


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