1997 Minnesota Statutes

     62S.01 Definitions. 

    Subdivision 1.    Application.  The definitions in this 
 section apply to this chapter. 

    Subd. 2.    Activities of daily living.  "Activities of 
 daily living" means eating, toileting, transferring, bathing, 
 dressing, and continence. 

    Subd. 3.    Acute condition.  "Acute condition" means 
 that the individual is medically unstable and requires frequent 
 monitoring by medical professionals, such as physicians and 
 registered nurses, in order to maintain the individual's health 
 status. 

    Subd. 4.    Adult day care.  "Adult day care" means a 
 program for six or more individuals of social and health-related 
 services provided during the day in a community group setting 
 for the purpose of supporting frail, impaired elderly, or other 
 disabled adults who can benefit from care in a group setting 
 outside the home. 

    Subd. 5.    Applicant.  "Applicant" means: 

    (1) in the case of an individual long-term care insurance 
 policy, the person who seeks to contract for benefits; or 

    (2) in the case of a group long-term care insurance policy, 
 the proposed certificate holder. 

    Subd. 6.    Bathing.  "Bathing" means washing oneself by 
 sponge bath; or in either a tub or shower, including the task of 
 getting into or out of the tub or shower. 

    Subd. 7.    Certificate.  "Certificate" means a 
 certificate issued under a group long-term care insurance policy 
 delivered or issued for delivery in this state. 

    Subd. 8.    Chronically ill individual.  "Chronically 
 ill individual" means an individual who has been certified by a 
 licensed health care practitioner, within the preceding 12-month 
 period, as either: 

    (1) being unable to perform, without substantial assistance 
 from another individual, at least two activities of daily living 
 for a period of at least 90 days due to a loss of functional 
 capacity; 

    (2) having a disability similar to the level of disability 
 described in clause (1); or 

    (3) requiring substantial supervision to protect the 
 individual from threats to health and safety due to severe 
 cognitive impairment. 

    Subd. 9.    Cognitive impairment.  "Cognitive impairment"
 means a deficiency in a person's short or long-term memory, 
 orientation as a person, place and time, deductive or abstract 
 reasoning, or judgment as it relates to safety awareness. 

    Subd. 10.    Commissioner.  "Commissioner" means the 
 commissioner of commerce. 

    Subd. 11.    Continence.  "Continence" means the ability 
 to maintain control of bowel and bladder function, or when 
 unable to maintain control of bowel or bladder function, the 
 ability to perform associated personal hygiene, including caring 
 for catheter or colostomy bag. 

    Subd. 12.    Dressing.  "Dressing" means putting on and 
 taking off all items of clothing and any necessary braces, 
 fasteners, or artificial limbs. 

    Subd. 13.    Eating.  "Eating" means feeding oneself by 
 getting food into the body from a receptacle, such as a plate, 
 cup, or table, or by a feeding tube or intravenously. 

    Subd. 14.    Functional capacity.  "Functional capacity" 
 means requiring the substantial assistance of another person to 
 perform the prescribed activities of daily living. 

    Subd. 15.    Group long-term care insurance.  "Group 
 long-term care insurance" means a long-term care insurance 
 policy delivered or issued for delivery in this state and issued 
 to: 

    (1) one or more employers or labor organizations, or to a 
 trust or to the trustees of a fund established by one or more 
 employers or labor organizations, or a combination, for 
 employees or former employees, or a combination, or for members 
 or former members, or a combination, of the labor organizations; 

    (2) a professional, trade, or occupational association for 
 its members or former or retired members, or combination, if the 
 association: 

    (i) is composed of individuals, all of whom are or were 
 actively engaged in the same profession, trade, or occupation; 
 and 

    (ii) has been maintained in good faith for purposes other 
 than obtaining insurance; 

    (3) an association or a trust or the trustee of a fund 
 established, created, or maintained for the benefit of members 
 of one or more associations.  Before advertising, marketing, or 
 offering the policy within this state, the association or the 
 insurer of the association must file evidence with the 
 commissioner that the association has at the outset a minimum of 
 100 persons and has been organized and maintained in good faith 
 for purposes other than that of obtaining insurance; has been in 
 active existence for at least one year; and has a constitution 
 and bylaws that provide that: 

    (i) the association holds regular meetings not less than 
 annually to further purposes of the members; 

    (ii) except for credit unions, the association collects 
 dues or solicits contributions from members; and 

    (iii) the members have voting privileges and representation 
 on the governing board and committees. 

 Thirty days after the filing, the association is considered to 
 have satisfied the organizational requirements, unless the 
 commissioner makes a finding that the association does not 
 satisfy the organizational requirements; or 

    (4) a group other than as described in clauses (1) to (3), 
 subject to a finding by the commissioner that: 

    (i) the issuance of the group policy is not contrary to the 
 best interest of the public; 

    (ii) the issuance of the group policy would result in 
 economies of acquisition or administration; and 

    (iii) the benefits are reasonable in relation to the 
 premiums charged. 

    Subd. 16.    Guaranteed renewable.  "Guaranteed 
 renewable" means the insured has the right to continue the 
 long-term care insurance in force by the timely payment of 
 premiums and the insurer has no unilateral right to make any 
 change in any provision of the policy or rider while the 
 insurance is in force and cannot decline to renew, except that 
 rates may be revised by the insurer on a class basis. 

    Subd. 17.    Home health care services.  "Home health 
 care services" means medical and nonmedical services provided to 
 ill, disabled, or infirm persons in their residences.  The 
 services may include homemaker services, assistance with 
 activities of daily living, and respite care services. 

    Subd. 18.    Long-term care insurance.  "Long-term care 
 insurance" means a qualified long-term care insurance policy or 
 rider advertised, marketed, offered, or designed to provide 
 coverage for not less than 12 consecutive months for each 
 covered person on an expense incurred, indemnity, prepaid, or 
 other basis for one or more necessary or medically necessary 
 diagnostic, preventive, therapeutic, rehabilitative, 
 maintenance, or personal care services, provided in a setting 
 other than an acute care unit of a hospital.  Long-term care 
 insurance includes: 

    (1) group and individual annuities and life insurance 
 policies or riders that provide directly or that supplement 
 long-term care insurance; and 

    (2) a policy or rider that provides for payment of benefits 
 based upon cognitive impairment or the loss of functional 
 capacity. 

 Long-term care insurance does not include an insurance policy 
 that is offered primarily to provide basic Medicare supplement 
 coverage, basic hospital expense coverage, basic 
 medical-surgical expense coverage, hospital confinement 
 indemnity coverage, major medical expense coverage, disability 
 income or related asset-protection coverage, accident only 
 coverage, specified disease or specified accident coverage, or 
 limited benefit health coverage.  With regard to life insurance, 
 long-term care insurance does not include life insurance 
 policies that accelerate the death benefit specifically for one 
 or more of the qualifying events of terminal illness, medical 
 conditions requiring extraordinary medical intervention, or 
 permanent institutional confinement, and that provide the option 
 of a lump-sum payment for those benefits and in which neither 
 the benefits nor the eligibility for the benefits is conditioned 
 upon the receipt of long-term care. 

    Subd. 19.    Maintenance or personal care services.  
 "Maintenance" or "personal care services" means any care the 
 primary purpose of which is the provision of needed assistance 
 with any of the disabilities as a result of which the individual 
 is a chronically ill individual, including the protection from 
 threats to health and safety due to severe cognitive impairment. 

    Subd. 20.    Medicare.  "Medicare" means The Health 
 Insurance for the Aged Act, Title XVIII of the Social Security 
 Amendments of 1965, as amended, or Title I, Part I, of Public 
 Law Number 89-97, as Enacted by the Eighty-Ninth Congress of the 
 United States of America, as amended. 

    Subd. 21.    Mental or nervous disorder.  "Mental or 
 nervous disorder" means a neurosis, psychoneurosis, psychopathy, 
 psychosis, or mental or emotional disease or disorder. 

    Subd. 22.    Noncancelable.  "Noncancelable" may be used 
 only when the insured has the right to continue the long-term 
 care insurance in force by the timely payment of premiums during 
 which period the insurer has no right to unilaterally make any 
 change in any provision of the insurance or in the premium rate. 

    Subd. 23.    Policy.  "Policy" means a policy, contract, 
 subscriber agreement, rider, or endorsement delivered or issued 
 for delivery in this state by an insurer; fraternal benefit 
 society; nonprofit health, hospital, or medical service 
 corporation; prepaid health plan; health maintenance 
 organization; or a similar organization. 

    Subd. 24.    Qualified long-term care insurance policy.  
 "Qualified long-term care insurance policy" means a policy that 
 meets the requirements of Section 7702(B) of the Internal 
 Revenue Code, as amended, and this chapter. 

    Subd. 25.    Qualified long-term care services.  
 "Qualified long-term care services" means necessary diagnostic, 
 preventive, therapeutic, curing, treating, mitigating, and 
 rehabilitative services and maintenance or personal care 
 services, which are: 

    (1) required by a chronically ill individual; and 

    (2) provided pursuant to a plan of care prescribed by a 
 licensed health care practitioner. 

    Subd. 26.    Toileting.  "Toileting" means getting to 
 and from the toilet, getting on and off the toilet, and 
 performing associated personal hygiene. 

    Subd. 27.    Transferring.  "Transferring" means moving 
 into or out of a bed, chair, or wheelchair. 

    HIST: 1997 c 71 art 1 s 1