long term care
individual policies
-18 to 84 -most common form of LTC being sold today -policies regulated by the state and can be customized to meet the insured's needs
qualified long-term care insurance
-30 day free look period -be guaranteed renewable contract -include optional nonforfeiture benefits -offer inflation protection options -comply with the NAIC model act which has been adopted by most states
standards
-30 day free look period -guaranteed renewable -renewal policy must be stated on first page -may be cancelled for nonpayment of premium -outline of coverage must be delivered to an applicant on the initial solicitation and prior to the presentation of the application form
pre-existing conditions
-6 months
benefit triggers
-acticities of daily living -cognitive impairment
types of contracts
-riders/endorsements for life insurance policies -individual policies -group voluntary policies
benefits
benefits received from qualified plan are not tax deductible
exclusions
-acute care (hospitalization) -rest cures -nervous or mental disorders which have no demonstrable organic cause -inury or sickness caused by acts of war, declared or undeclared -intentionally self-inflicted injuries -chemical dependency unless it results from the administration of drugs under a physicians prescription and direction -conditions covered under workers comp -injury arising out of committing or attempting to commit a felony -services provided outside the US
benefit period
-amount of time benefits will be paid upon a loss, which is not same as how long the policy is in force -begins at end of elimination period -such as 2, 5, or 10 years to, to age 65, or a lifetime benefit may be selected -longer the benefit period, higher the premium
definition
-any individual policy, group policy or rider that is advertised, marketed, offered, solicited, or designed to provide coverage for no less than 12 consecutive months -also referred to as Extended Care -may cover diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than acute care unit of a hospital
activities of daily living
-bathing -continence -dressing -eating -toileting -transferring *if insured is incapable of performing 2 or more,beenfits will be triggered *considered to be functionally impaired
prohibited provisions
-cancels, non renews, or terminates the policy on the grounds of age or deterioration of the mental or physical health of the insured. may only be cancelled by insurer for nonpayment of premium -establishes a new waiting period when exiting coverage is converted or replaced by a new form, except when the insured voluntarily selects an increase in benefits -provides coverage for only skilled nursing care instead of lower levels of care
skilled nursing care
-continuous 24-hour care provided by registered nurse -specialized services such as feeding tubes, IV therapy, and wound care -provided in licensed facility, such as nursing home, that operates according tot eh laws of the state and requires a licensed physician to be responsible for patient care
intermediate care
-daily but not 24 hour care, provided by licensed medical professional -care designed to assist with daily medical needs, such as dispensing mediation -"in-between" care to hep patients requiring less than skilled care remain independent and to prevent unnecessary -usually provided in a nursing home, intermediate-care unit, or assisted living facility that is licensed by state and requires licensed physician to be responsible for all patient care
group voluntary policies
-do not require enrollment as long as they are guaranteed renewable and convertible in the event the group policy is terminated for any reason
other coverages
-home health care -hospice care -assisted living -adult day care -respite care
ride3rs/endorsements for life insurance policies
-hybrid long term care policies that combine the benefits of a life insurance policy with a traditional long-term care contract -guarantees long-term care benefits, but will provide a death benefit if no care is needed
premiums
-if premiums paid for individual qualified LTC polices that exceed 10% of the individuals adjusted gross income may be tax deductible -invididuals 65 or older, premiums paid for individual LTC policies that exceed 7.5% of adjusted gross income may be tax deductible
cognitive impairment
-loss of memory and deductive or abstract reasoning due to an organic mental illness -impairment in any of the ADL's is not required under classification
elimination period
-may be as short as 30 days and as long as 1 year -90 days most common -waiting period after a loss occurs before the benefit period begins -shorter elimination period, higher the premium
inflation protection
-must offer the insured the option of purchasing inflation protection which increases the daily benefit amount in the future, is not required to be purchased -typically offer simple and compound inflation protection
custodial care
-non-medical care to provide assistance with activities of daily living such as bathing, toileting, eating, dressing, transferring and continence -must be recommended by a doctor -carefiver can be family member -may be provided in licensed facility or ones own home
nonforfeiture options
-provides paid-up coverage if the insured cancels or lapses the policy due to nonpayment of premium -amount will be used to provide future benefits based on the premiums that were paid into the policy --cash surrender value --reduced paid-up --extended term
policy options
-waiver of premium -inflaiton protection -nonforeiture options
cas surrender value
provides a lump sum payment of surrender values accumulated in the policy
waiver of premium
provides for premiums to be waived after the stated elimination period has elapsed and for as long as disability continues
extended term
provides for the current daily benefit limit to be paid for a reduced number of years based on the discontinuance of premium payments
reduced paid-up
reduces the daily benefit for the duration of the benefit period once premiums have been discontinued
