Employers have no obligation under California law to offer long-term care insurance to their employees. However, if long-term care insurance is among the benefits offered, certain state law requirements limit how the plan may be designed.
In California, the term “long-term care insurance” includes any insurance policy, certificate, or rider that is advertised, marketed, offered, solicited, or designed to provide coverage for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services that are provided in a setting other than an acute care unit of a hospital. (CA Ins. Code Sec. 10231.2). Long-term care insurance includes all products containing any of the following benefit types:
• Coverage for institutional care, including care in a nursing home, convalescent facility, extended care facility, custodial care facility, skilled nursing facility, or personal care home;
• Homecare coverage, including home health care, personal care, homemaker services, hospice, or respite care; or
• Community-based coverage, including adult day care, hospice, or respite care.
However, although long-term care insurance includes disability-based, long-term care policies, it does not include insurance that is mainly designed to provide Medicare supplement or major medical expense coverage.
Generally, group long-term care insurance issued in California must provide for continuation or conversion of coverage when coverage terminates (CA Ins. Code Sec. 10236.5). The insurer may require that an individual must have been continuously insured under the group policy, or any group policy which it replaced, for at least six months immediately prior ...