LONG TERM CARE 9
California Department of Insurance
Protecting California Consumers
Toll Free 800-927-HELP
pay. Federal law prohibits the use of a medical necessity
trigger in tax-qualified long-term care insurance policies.
Conditions To The Payment Of Benefits
All policies will require you to meet certain “conditions”
after the “benefit triggers” have been met and before benefits
will be paid.
Elimination Periods
The Elimination Period (sometimes called a “Waiting Period”
or “Deductible Period”) is the period of time you must wait
after you qualify for care, and are eligible to receive benefits
before the company will begin paying for your care. You choose
the length of the Elimination Period when you buy the policy.
The most common options are 0 days, 30 days, 60 days, 90 days
or 100 days. Some policies only make you meet the Elimination
Period once during the life of the policy, others apply it
again after you have gone for a certain period of time without
needing care. In most situations the elimination period will
be satisfied by a day of either in home care or institutional
care.
The premiums are usually more for short elimination periods
and less for a longer one. Be sure to ask your qualified agent
to explain these differences. The elimination or deductible
period is the length of time that the insurer pays no benefits.
If you select a 0-day Elimination Period, the policy will
begin paying on the first day you qualify for care. If you
choose one of the other periods you will be responsible for
paying the full cost of your care for these days.
Example: If you choose an Elimination Period of 60 days,
you will be responsible for the cost of the first 60 days
of your care. If you are in a nursing home that charges you
$100 per day, you will pay approximately $6,000, before the
policy starts paying. If you leave the nursing home before
the 60 days expires and the policy only pays for institutional
care, it would pay nothing for that period of care. If you
qualify for benefits in a home care setting most long-term
care insurance policies apply a day towards your Elimination
Period for any day you actually receive care (or a home care
visit). Therefore, if your plan of care only calls for 3 visits
per week you will only satisfy 3 days towards your Elimination
Period.
Some companies offer a more liberal interpretation of this
definition. For example, the policy might say that if you
have one home care visit per calendar week that you’ve satisfied
7 days towards your Elimination Period. In this example, you
would satisfy your Elimination Period more quickly. Several
companies now utilize a “calendar day” definition for the
elimination period. Once the insured has been certified as
being chronically ill each calendar day counts towards the
elimination period, regardless of whether formal long-term
care services are received. This allows the insured person
to get informal care from family or friends during the elimination
period. After the elimination period has been satisfied formal
paid care can begin. The premium cost is usually higher if
you choose the shorter Elimination Periods and is lower if
you choose a longer period. In addition a premium might be
higher when the company uses a more liberal “counting” of
home care Elimination Period days. Also, make sure that the
Elimination Period days that.
Long Term Insurance 1
Long Term Insurance 2
Long Term Insurance 3
Long Term Insurance 4
Long Term Insurance 5
Long Term Insurance 6
Long Term Insurance 7
Long Term Insurance 8
Long Term Insurance 9
Long Term Insurance 10
Long Term Insurance 11
Long Term Insurance 12
Long Term Insurance 13
Long Term Insurance 14
Long Term Insurance 15
Long Term Insurance 16
Long Term Insurance 17
Long Term Insurance 18
Long Term Insurance 19
Long Term Insurance 20
