Category Archives: Insurance Terms

Long Term Care Terms

Long Term Care Terms

You will find definitions of terms commonly used terms in Long-Term Care Policy

Activities of Daily Living
The following functions for personal independence in every day living and are used as the measurement standard to determine your functioning capacity. These ADLs are a national standard for tax-qualified long-term care plans.

These are the Activities of Daily Living:

  • Bathing: Your ability to wash yourself, including a sponge bath, or in a tub or shower, including the task of getting into and out of the tub or shower.
  • Continence: Your ability to control bowel and bladder function; or when unable to maintain control of bowel and bladder function, your ability to perform associated personal hygiene (including caring for catheter or colostomy bag).
  • Dressing: Your ability to put on and take off all items of clothing and any necessary braces or artificial limbs usually worn, and to fasten and unfasten them.
  • Eating: Your ability to feed yourself by getting food into your body from a receptacle (such as a plate, cup or table) or by a feeding tube intravenously.
  • Toileting: Your ability to go to and from the toilet and maintain a reasonable level of personal hygiene. This includes getting on and off the toilet and caring for clothing.
  • Transferring: Your ability to move in and out of a bed, chair or wheelchair.

The certification by a licensed health care practitioner must be made at least annually.

Adult Day Care
A program for six or more individuals of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired, elderly or other adults with a disability who can benefit from care in a group setting outside the home.

Cost of Waiting
Definition: The total cost of premiums paid at one age versus the cost of premiums paid if purchased at a later age.

Cognitive Impairment*
A deficiency in a person’s short or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.
*see Severe Cognitive Impairment

Custodial Care
Care given primarily for the purpose of assisting another with Activities of Daily Living (ADLs).  Custodial Care is not intended to restore health or the ability to function. It can be provided by a non-medically trained professional.

Daily Benefit Amount
The maximum amount of money you will be reimbursed for services during each day you are eligible for qualified long-term care benefits.

Elimination Period

The number of days (waiting period) before LTC will pay covered benefits under your policy. You need only satisfy this elimination period once in your lifetime.

Standard elimination period options are 30, 60 and 90 days. These days need not be consecutive and may be accumulated until your elimination period has been met.

Home Care
Care provided to a person in his or her home primarily to assist with Activities of Daily Living (ADLs).

Home Health Care
A program of professional, paraprofessional or skilled care provided through a home health care agency to an insured in his or her home.

Inflation Protection
If you choose to add Inflation Protection to your contract, you can increase your Maximum
Monthly Benefit to protect against the anticipated increases in the cost of
long term care.

Nonforfeiture
With these riders, you can add a contract feature that returns at least part of the premiums you paid if you cancel your contract or let it lapse:

  • Contingent Nonforfeiture (included in base) or
  • Shortened Benefit Period Continued coverage equal to premiums you have paid if your contract has been in force for three years and lapses.
  • Full Return of Premium* If you die while the contract is in force, we will refund all premiums you have paid for the contract and riders. Available only to enrollees age 65 and under.
  • Return of Premium*  The same protection as Full Return of Premium except any benefits paid or payable are deducted. Available only to enrollees age 75 and under.


Respite Care

Temporary relief from caregiving duties from a member of the immediate family or other person who is the unpaid primary caregiver. This “time off” helps the primary caregiver maintain his or her health and mental well-being.

Restoration of Benefits
Whenever a period of 180 days elapses in which you were not chronically ill, we will restore your Lifetime Maximum to what it would have been had no benefits been paid under your contract. Not available with Unlimited Lifetime Maximum. Not available in conjunction with the Shared Care Rider.

Severe Cognitive Impairment
The deterioration or loss in intellectual capacity that requires Substantial Supervision to assure the insured’s and others’ safety. The deterioration or loss is established by clinical evidence and standardized tests that reliably measure:

  • Short-term or long-term memory
  • Orientation as to people, place, or time
  • Deductive or abstract reasoning; and judgment as it relates to safety awareness.

Skilled Nursing
A level of care that is provided by a registered nurse and is prescribed by a doctor for the medical care of the individual.

Spending Down
Spending down is when you, or your family, spend all your assets to reach the level where Medicaid will cover your LTC expenses. Not only will this action deeply effect your surviving spouse, but it can also take away your freedom of choice. Most facilities have a limited number of Medicaid beds, if they accept Medicaid at all. Medicaid has a significant number of restrictions on Home and Facility care, approved caregivers and the location of that care.

Coinsurance

When looking at health insurance plans, it is not uncommon to see the term coinsurance.  Coinsurance simply means the percentage of covered expenses under a medical insurance plan that is paid by the insurance company once a deductible is satisfied.  For example if you hear the term 80/20 plan.  That means that after the deductible is met you the subscriber will pay 20% and the insurance company will pay 80%.  You will continue to pay that 20% up until you reach the annual coinsurance maximum, and then the insurance company will pay 100% up to the policy maximums.

Make sure you check your policy for it’s definitions.  If you purchased your insurance through me or are looking to use me as your agent, I would be more than happy to go over this with you.