Chapter 15/8: Long-term Care - Provisions and Disclosures

All the following exclusions are permitted in a long-term care insurance policy, EXCEPT:

Alzheimer_s disease cannot be excluded from coverage. The correct answer is: Alzheimer_s disease

All of the following medical conditions are excluded from coverage under a long-term care policy, EXCEPT:

Alzheimer_s disease must be covered. Pre-existing conditions are excluded for the first 6 months after the policy effective date. The correct answer is: Alzheimer_s disease

The outline of coverage for long-term care policies is also referred to as:

Applicants must be provided with a shopper_s guide (outline of coverage) upon initial solicitation, prior to completing the policy application. This document explains policy features such as premiums, policy renewability, conversion and exclusions. The correct answer is: Shopper_s guide

A long-term care insurance policy must contain which of the following provisions?

As a result of the 1996 Health Insurance Portability and Accountability Act (HIPAA), all long-term care policies sold today must be guaranteed renewable. The insurer cannot cancel the policy and must renew coverage each year, as long as the insured pays the premiums. The correct answer is: Guaranteed renewability

An elimination period for long-term care policies that is counted based on the number of days the insured receives care is called:

Elimination periods are counted on a service day basis (days receiving care) or calendar day basis (days are counted once an individual is eligible for LTC benefits). The correct answer is: Service day basis.

How long is the conversion period for group long-term care policies?

Individuals must apply for the individual long-term care coverage and pay the premium within 31 days of the group long-term care coverage termination date. The correct answer is: 31 days

All of the following are long-term care underwriting considerations, EXCEPT:

Individuals who are over the age of 80 applying for a long-term care (LTC) policy must undergo a physical exam, ADL evaluation, and provide medical records and attending physician_s statement. Post-claims underwriting, in which all applicants are issued coverage, but later denied claims for health or other reasons, is prohibited in LTC policies. Insurers must carefully determine an applicant_s insurability upon application. The applicant must receive a copy of the application upon policy delivery, at the latest. The correct answer is: Post-claims underwriting is acceptable for insureds over the age of 80.

Which of the following is not an optional benefit provided by LTC policies?

LTC policies must be guaranteed renewable or noncancelable. The correct answer is: Guaranteed renewable or noncancelable

All of the following may be excluded under a LTC policy, EXCEPT:

LTC policies must cover Alzheimer's disease. The correct answer is: Alzheimer's disease

Long-term care policies must be at least:

Long-term care policies are either guaranteed renewable or noncancelable. The correct answer is: Guaranteed renewable

Long-term care policies can limit or exclude coverage for all of the following, EXCEPT:

Long-term care policies can limit or exclude a variety of problems, but they cannot exclude coverage because of a family history of heart disease or of a similar disease that is not entirely genetic and thus predictable. Nor can they use genetic testing to exclude coverage. The correct answer is: Family history of heart condition

Which of the following is not a requirement for qualified long-term care plans?

Long-term care policies cannot accrue cash value. The correct answer is: Policies must accrue cash value.

Long-term care policies contain all of the following provisions, EXCEPT:

Long-term care policies cannot restrict coverage to only skilled care. The correct answer is: Restricted coverage to skilled care only

All of the following are optional benefits in a long-term care policy, EXCEPT:

Long-term care policies must be guaranteed renewable or noncancelable. The correct answer is: Guaranteed renewable or noncancelable

All of the following are true regarding a long-term care policy elimination period, EXCEPT:

Many long-term care (LTC ) policies have an elimination period similar to that found in a disability income policy, after which LTC benefits begin. In the case of LTC, the elimination period is usually 30 days or longer, during which period the insured must be confined to a nursing facility. LTC policies with longer elimination periods have lower premiums. The correct answer is: The insured is not required to be confined to a nursing facility during the elimination period.

In a long-term care policy, pre-existing conditions must be covered after:

Many long-term care (LTC) policies do not cover pre-existing conditions which were present six months prior to the policy_s effective date. This is the most restrictive definition of pre-existing conditions an insurer can use. Six months after the effective date of coverage, all pre-existing conditions must be covered. The correct answer is: 6 months from the effective date of coverage

Which of the following is true regarding the treatment of pre-existing conditions in Medigap and LTC polices?

Pre-existing conditions which were present 6 months prior to the policy's effective date may be excluded for a maximum of 6 months after the effective date of coverage. The correct answer is: Pre-existing conditions which were present six months prior to the policy's effective date may be excluded for a maximum of six months after the effective date of coverage.

Which of the following provisions must be included in a long-term insurance policy?

The Health Insurance Portability and Accountability Act (HIPAA) mandated that all long-term care policies must be guaranteed renewable. The insurer cannot cancel the policy and must renew coverage each year so long as the insured pays the premiums. The correct answer is: Guaranteed renewability

All of the following are requirements for qualified long-term care plans, EXCEPT:

The individual must require long-term care for at least 90 days. The correct answer is: The individual must require long-term care for at least 30 days.