§ 18-101. Definitions

   (a) In general. -- In this title the following words have the meanings indicated.

(b) Alzheimer's disease. -- "Alzheimer's disease" means a progressive brain disease diagnosed as Alzheimer's disease by the licensed attending physician of the insured or certificate holder and confirmed by a second opinion of a licensed physician.

(c) Applicant. -- "Applicant" means:

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

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

(d) Carrier. -- "Carrier" means an insurer, nonprofit health service plan, health maintenance organization, or preferred provider organization.

(e) Certificate. -- "Certificate" means a certificate that is issued under a group policy of long-term care insurance if the certificate is delivered or issued for delivery in the State and covers individuals who reside in the State.

(f) Long-term care insurance. --

   (1) "Long-term care insurance" means an individual or group policy, contract, certificate, or rider that:

      (i) is issued, delivered, or offered by a carrier;

      (ii) is advertised, marketed, offered, or designed to provide coverage for at least 24 consecutive months for each covered individual on an expense-incurred, indemnity, prepaid, or insured basis; and

      (iii) provides one or more necessary or appropriate diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital.

   (2) "Long-term care insurance" includes any product that is advertised, marketed, or offered as long-term care insurance.

   (3) "Long-term care insurance" does not include:

      (i) a policy, contract, certificate, or rider that is offered primarily to provide:

         1. basic Medicare supplement coverage;

         2. hospital confinement indemnity coverage;

         3. basic hospital expense or medical surgical expense coverage;

         4. disability income protection coverage;

         5. accident-only coverage;

         6. specified disease or specified accident coverage; or

         7. skilled nursing care;

      (ii) a life insurance policy that:

         1. accelerates the death benefit specifically for:

            A. one or more of the qualifying events of terminal illness;

            B. a medical condition that requires extraordinary medical intervention; or

            C. permanent institutional confinement;

         2. provides the option of lump-sum payments for the benefits listed in item 1 of this subparagraph; or

         3. does not make benefits or eligibility for benefits conditional on receipt of long-term care; or

      (iii) a certificate that is issued under an out-of-state employer group contract.

(g) Loss ratio. -- "Loss ratio" means the ratio of losses incurred to premiums earned on policies that are issued, delivered, or renewed in the State.

(h) Out-of-state employer group contract. -- "Out-of-state employer group contract" means a group contract that:

   (1) is entered into with an employer in a state other than this State; and

   (2) is issued directly to an employer under the laws of that employer's state.

(i) Preexisting condition. -- "Preexisting condition" means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within 6 months before the effective date of coverage of the insured or certificate holder.

HISTORY: An. Code 1957, art. 48A, § 642; 1997, ch. 35, § 2; 2008, chs. 631, 632.