Health · Chapter 22 · Long-Term Care
Florida LTC Policy Standards (F.S. 627.9407; 69O-157, F.A.C.)
Definition
In Florida, an LTC policy must: give a 30-day free look; be issued "guaranteed renewable" or better ("level premium" may be claimed only when the insurer has NO right to change premium); base rates on ISSUE age, never an attained age that auto-increases; never be canceled, nonrenewed, or terminated based on age or health; impose no new waiting periods on conversion or internal replacement (except for requested benefit increases); not restrict coverage to skilled-nursing-facility care or pay significantly less for other levels; contain an elimination period of no more than 180 days; and never require prior hospitalization to claim benefits. Minimum benefits (F.A.C. 69O-157.009): at least twenty-four (24) months of nursing home coverage PLUS at least one "lower level" of care paid at 50% or more of the nursing home benefit (a $100/day nursing benefit needs a $50+/day lower-level benefit; note 69O-157.104(4)(a) sunsets the 24-month piece for coverage issued/renewed after July 1, 2006, though course materials still teach it) — lower levels include nursing services, assisted living facilities, home health agencies, adult day care centers, adult foster homes, community care for the elderly, personal care, and social services.
In plain English
Priced off the age you bought it, renewable for life, no hospital-stay hoops, and never a nursing-home-only contract.
Exam tip
⚠️ Issue age vs attained age is the LTC pricing trap; the benefit-floor pair is 24 months + 50%.
Related terms