- Activities of Daily Living (ADLs)-Activities that measure a person’s level of dependence. These activities include bathing, continence, dressing, eating, toileting, transferring (mobility). Your policy must pay benefits if you are unable to perform the specified number of ADLs.
- Adult Day Care-Daytime, community-based programs for functionally impaired or disabled
adults that provide a variety of health, social and related services. Its purpose is to enable
individuals to remain at home and to provide family members relief from constant care.
- Alternate Care Facility-Facility that is primarily engaged in providing ongoing long-term
care, has a trained employee available 24 hours a day, and provides 3 meals a day,
accommodating special diets.
- Alzheimer’s Disease-A progressive, degenerative form of dementia that causes severe
- Assisted Living Facilities-Residential care settings providing the frail elderly with personal
care services, shopping, housekeeping, and transportation.
- Bed Reservation-This policy benefit covers the payment to a Nursing Home Facility when a
policyholder is temporarily hospitalized, to reserve his or her room.
- Benefit-Amount payable by the insurance company when the insured suffers a loss covered
by the policy.
- Benefit Period-Length of time a specific benefit will be paid. It begins when the insured
becomes eligible for benefits and ends when the insured has been out of claim status for a
given period of time.
- Chronically Ill Individual-A person who has been certified by a licensed health care
practitioner as being unable to perform at least 2 ADLs for at least 90 days due to a loss of functional capacity or requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.
- Cognitive Impairment-A Long-Term Care policy must pay for services when a deficiency in a person’s short or long-term memory requires substantial supervision to maintain safety of the insureds and those around them. A doctor must certify cognitive impairment.
- Company Care Coordinator-A professional who can work with you and your family to determine the appropriate Plan of Care. In most cases, the coordinator must be approved or recommended by the insurance company.
- Custodial Care-Care to help individuals meet personal needs such as bathing, dressing, and eating. Someone without professional training may provide care.
- Daily Benefit-The amount of insurance benefits that a policy will pay per day for covered long-term care expenses.
- Elimination Period-A type of deductible; the number of days the individual must pay out of pocket for covered services before the insurance company will begin to make payments. The longer the elimination period, the lower the premium.
- Emergency Systems-Includes but is not limited to the following: Installation and monthly service of a medical alert system, local services by a licensed ambulance.
- Extended Care Facility-Assisted Living Facility.
- Guaranteed Purchase Option (GPO) -This benefit guarantees a policyholder the right to
purchase additional units of a daily benefit.
- Guaranteed Renewable - When a policy cannot be cancelled and must be renewed by the
company when it expires unless benefits have been exhausted. The company cannot change
the coverage or refuse to renew the coverage for anything but non-payment of premiums.
- HIPAA- “Health Insurance Portability and Accountability Act” Federal legislation passed in 1996 that allows, under specified conditions, for long-term care policies to be qualified for
certain tax benefits.
- Home Health Care (HHC) -Services include but are not limited to: part-time skilled nursing
care, speech, physical or occupational therapy, homemaker services, home health aide,
assistance with ADLs, adult day care, personal care, hospice services and respite care.
- Homemaker Services-Basic domestic services that are provided at home to assist a person with chronic illness or disability to remain at home and as independent as possible. Services
include housekeeping, cooking, transportation, shopping and bathing.
- Hospice-Care provided to terminally ill patients and their families that emphasizes patient
comfort rather than cure. Addresses emotional needs such as coping with pain and death.
- Incurred Payment Disbursement-This payment method will pay less than the daily maximum if the actual cost for services is less. For instance, if the policy has a $100 Daily Benefit, but the actual expenses are only $80 a day, the policy would only pay $80 a day.
- Indemnity Payment Disbursement-This payment method will pay the actual dollar amount of the benefit regardless of the cost of services. For example, if the policy has a $100 Daily Benefit, the policy would pay $100, even if the actual cost of the service rendered were $75 or $125.
- Inflation Protection-Allows policyholder to increase insurance benefits over time to offset higher service costs associated with inflation.
- Intermediate Care-Occasional nursing and rehabilitative care that must be based on a doctor’s orders and can only be performed by, or under the supervision of, skilled medical personnel.
- Lapse-Termination of a policy when a renewal premium is not paid.
- Medicaid-A joint federal/state program that pays for health care services for those with low
incomes or very high medical bills relative to income and assets.
- Medicare-The federal program providing hospital and medical insurance to people aged 65
or older and to certain ill or disabled persons. Benefits paid for nursing home and home
health care services are limited.
- Non Tax-Qualified Policy-Policyholders cannot claim deductions for long-term care
premiums on non tax-qualified plans.
- Non-cancelable Policies-Insurance contract that cannot be cancelled. Also, the insurance
company cannot change the rates.
- Non-forfeiture Benefit-Insurance feature that, upon voluntary termination of premiums,
allows the full daily benefit to be paid for a shortened benefit period.
- Nursing Home Care (NHC) -Care in a licensed nursing facility; includes Assisted Living
- Outline of Coverage (OC) -Provides a very brief description of the important features of the
policy. You should compare this outline of coverage to outlines of coverage for other policies.
This is not an insurance contract.
- Policy Form Number-A unique number used for policy identification.
- Pre-existing Conditions-Medical conditions, illness or disability that existed before a
person purchases an insurance policy.
- Premium-The amount paid by the policyholder in return for protection against financial
loss due to occurrence of an event.
- Rescind-When the insurance company voids or cancels a policy.
- Respite Care-Short-term care to a dependent individual to alleviate stress and relieve family
- Restoration of Benefits-Once a policyholder is treatment free for at least 6 consecutive
months, benefits already paid will be ignored in determining the Lifetime Maximum Benefit
for future Long-Term Care facility stays.
- Return of Premium (ROP) -A non-forfeiture benefit that is pre-defined to return a certain
portion of premiums paid at a time when premium payments cease. Usually any claims paid
are deducted for ROP.
- Shortened Benefit Rider-Insurance feature that, upon voluntary termination of premiums,
allows the full daily benefit to be paid for a shortened benefit period.
- Skilled Nursing Care-Daily nursing and rehabilitative care that can be performed only by,
or under the supervision of, skilled medical personnel. The care received must be based on a
- Tax-Qualified Policy-Plans that allow policyholders to deduct their long term care
premiums as medical expenses on his or her income tax return, up to a specified amount.
- Underwriting-The process of examining, accepting, or rejecting insurance risks, and
classifying policyholders in order to charge the proper premium.
- Waiver of Premium-A provision that relieves the insured from paying premiums while