CH15 LTC PLAN
a couple buying 7-year LTC policies decides to purchase shared care policies. the husband later uses 3 years, how many left for wife?
11 years 7*2-3
When does Medicare cover nursing home care?
Only if it is part of treatment for a covered illness or injury [medicare will not cover LTC or nursing home care unless it is part of the treatment for a covered illness or injury]
what type of care is respite care
Relief for a major care giver
which of the following is NOT covered under a long-term care policy
acute care in a hospital急诊 [COVER: home health care, adult day care, hospice care or respite care]
which of the following long-term care benefits would provide coverage for care for functionality impaired adults on a less than 24 hours basis
adult day care [for who require assistance with various ADLs on a daily basis, but not around the clock]
LTC must cover
alzheimer's disease
in a shared-care policy, the benefits of 2 LTC policies
are split between the couple who signed the contract [a couple pools the benefits of two LTC policies, and splits them. if 2 people buy two 5 years policies, total 10 years of LTC]
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?
attending physician [home health care is care provided in one's home and could include occasional visits to the person's home by registered nurses, licensed practical nurses, licensed vocational nurses, or community-based organizations life hospice. may include physical therapy and some custodial care such as meal preparation]
in which of the following scenarios will repayment of funds take place per the medicaid estate recovery act?
before her death, a 23-year-old was living in a LT nursing facility paid for with medicaid funds
prior to issuance of a long-term care policy to an applicant age 80 or older, the insurer must obtain all of the following except
date of previous doctor visit [PROVIDE physical exam report, attending physician's report and copies of medical records]
which of the following statements is true regarding LTC insurance
every policy must offer nonforfeiture benefits to the applicant
Regarding long-term care coverage, as the elimination period gets shorter, the premium
gets higher [usually 2-5 years, longer period, shorter elimination period, higher premium]
what option allows the insured to periodically increase benefit levels without providing evidence of insurability?
guarantee of insurability
what option allows the insured to periodically increase benefit levels without providing evidence of insurability
guarantee of insurability 5% compounded annual increase
Most LTC plans have which of the following features?
guaranteed renewability
which is NOT provided in an institutional setting for LTC
home health care [given in the home. but skilled nursing, intermediate, and custodial care may all be provided in an institutional setting]
in which of the following locations would skilled care most likely be provided?
in an institutional setting
in LTC, as the benefit period lengthens, the premium
increases
who is responsible for making sure that agents are properly trained in the use of the suitability standards for LTC policies
insurer
what is the purpose of the NY partnership for LTC?
it combines LTC insurance and medicaid to help people for nursing home care
which of the following statements is correct
medicare will cover nursing home care if it is part of the treatment for a covered illness
Which renewal provision(s) must be included in a long-term care policy issued to an individual?
noncancellable and guaranteed renewable
in lTC, what type of care is provided with intermediate care
occasional nursing or rehabilitative care
how is the state of NY trying to encourage its residents to purchase long-term care insurance policies
offering tax credits on LTC policy premium
which of the following is not specifically prohibited by state law as an unfair trade practice?
reducing the premiums paid by employers for group insurance based on loss experience [insurers are permitted to lower the premiums of employer's group insurance bc of loss experience=> EXPERIENCE RATING]
which WOULD NOT allow an insured to receive care at home
skilled care
which does NOT have to be disclosed in a LTC
the aggregate amount of premiums due
what is necessary in order to be eligible to receive benefits from a long-term care policy
the insured must be unable to perform some activities of daily living
Regarding the return of premium option for LTC policies, what happens to the premium if the policy lapses?
the insurer will return a % of premium paid [return of premium optional nonforfeiture type benefit is offered by most insurers writing long term care policies. in the event of insured dies or policy is lapsed.]
which is true regarding optional benefits with LTC
they are available for additional premium
what do LTC policies offer to policyholder to account for inflation?
they offer the option of purchasing coverage that raises benefit levels accordingly
what types of services may NOT be provided under the long term care's assisted living care
visits by a registered nurse [INCLUDE linens and personal laundry service, assistance with dressing and bathing, reminders medication, assistance with eating. ADL offers nonmedical assistance]
what types of services may NOT be provided under the LTC's assisted living care?
visits by a registered nurse [PROVIDE: linens and personal laundry, dressing bathing, medication reminder, eating]
if seeking repayments of medicaid funds per the medicaid estate recovery act would cause a hardship to survivors, states may
waive the estate recovery requirement [states are allowed to waive estate recovery actions if the recovery of medicaid funds would cause an undue hardship]
an agent is completing an application for LTC. the agent is required to do all of the following except
warn the applicant about the 10 day free look period [30 day free look]
