Activities Of Daily Living (ADL): In federally tax-qualified policies six ADLs trigger the receipt of benefits: bathing, continence, dressing, eating, transferring and toileting. You must need assistance with at least 2 of the 6 ADLs (or have a cognitive impairment) to be eligible for benefits.
Adult Day Care: Social and other personal services including supervision and assistance with some ADLS are provided during the day in a community setting for those who do not require 24-hour care. Adult day care facilities are often used in conjunction with family and home caregivers to provide respite for primary caregivers.
Alternative Plan Of Care: With this benefit, the carrier will pay for new or emerging services not specifically defined under the long-term care plan, if they become available after the policy has been issued and are a reasonable substitute under the individual's plan of care.
Assisted Living Facility: Assisted Living Facilities (called Residential Care Facilities in California) provide individualized personal and health care in a residential setting for people who need assistance with ADLs and are unable to live independently but do not require the level of round-the-clock care provided in a nursing home.
Bathing: Taking an unassisted sponge bath in a shower or tub, including getting in and out of the shower or tub.
Bed Reservation Benefit: Pays the cost of keeping your place in a facility should you need or want to leave for an extended period (visit family or hospital stay).
Benefit Triggers: In a tax-qualified policy, the requirement that a licensed health care professional has certified that you will need assistance for at least 90 days with at least 2 of the 6 activities of daily living and/or have a severe cognitive impairment in order for you to be eligible to receive benefits.
Care Coordination/Care Management: A licensed health care professional assesses your Long Term Care needs and develops a Plan of Care to oversee your long-term care. The plan will cover the frequency and type of care, if the care will be informal, formal or a combination of both. Usually you will receive a list of formal care providers in your area.
Chronic Illness: An illness that usually has no specific cure and requires care for an extended period of time.
Cognitive Impairment: Deterioration of the ability to communicate, reason and understand; loss of identity, language and memory. Severe cognitive impairment is a symptom of Alzheimer's and other forms of dementia.
Comprehensive Policy: A Long-Term Care insurance policy that covers care in multiple settings including facility and in-home care.
Continence: The ability to control bladder and bowel functions including using a colostomy bag or catheter.
Custodial (Personal) Care: Assistance with activities of daily living provided by informal or trained caregivers. This care is usually not covered by health insurance plans.
Daily Benefit: The daily dollar amount your policy will pay for covered services.
Dressing: Putting on and taking off clothing including artificial limbs.
Eating: Feeding yourself without assistance from a cup or plate or via a feeding tube or IV.
Elimination Period (Deductible, Waiting Period): The number of days after you have qualified for and have begun to receive services before the policy begins to pay benefits. The most common waiting periods are 30, 60 or 90 days. Some policies do not have an elimination period for home care and pay benefits from the first day of service.
Facility Only Policy: To receive benefits are you must be in a licensed Long Term Care facility, i.e., a Nursing Home or Assisted Living Facility.
Free Look Period: A provision which allows you to cancel the policy for a full refund within 30 days of receiving the policy.
Guaranteed Renewable: Your insurance company cannot cancel your policy or change any of the benefits, unless you fail to pay the premiums. Insurance companies can increase premiums for a "class" of policies, but not for individuals due to a change in health or any other reason.
Hands-On Assistance: The physical assistance of another person without which you would be unable to perform one of the Activities of Daily Living.
Home Health Care: Skilled and unskilled long-term care services provided by home health aides who provide custodial care in your home and homemakers who assist with household chores such as cooking and housekeeping.
Hospice Care: Supportive and palliative care for people in the final phase of a terminal illness. Provides emotional, physical and spiritual support at home or in a hospice facility.
Inflation Protection: A rider you that should be a part of your Long Term Care insurance plan. This rider increases the amount of your benefits over time to account for inflation.
Informal Care: Usually unpaid and unlicensed care provided at home by family and friends of a loved one. Paid caregivers are brought in to give informal caregivers some time off.
International Benefits: Some policies will pay for covered services received outside the United States.
Lapse: Termination of a policy when the premium is not paid.
Lifetime Maximum Benefit (Your pool of money): The amount of dollars available to you over the life of your policy. Calculated by multiplying your Maximum Daily Benefit times your Benefit Period in days. For example, if your MDB is $200 and your benefit period is 3 years (1,095 days) your pool of money is $219,000.
Long-Term Care Insurance Trade Association: The American Association for Long-Term Care Insurance is the industry trade organization.
Medicaid (MediCal): Medicaid (Medical in California) is a joint federal and state program that provides health care services for people with low incomes and limited assets. Offers limited coverage of qualified long-term care expenses.
Medicare: A federal program to provide hospital and medical insurance to people age 65 and older and to certain ill or disabled persons. Benefits for Long Term Care are very limited.
Non-Forfeiture Benefit: Allows you to retain some limited policy benefits (usually equal to the amount of premiums paid-in) if you lapse your policy.
Partnership-Certified Policy: A Long-Term Care insurance policy approved by your state. If you exhaust the pool of money in your partnership-certified policy and apply for Medicaid, you can protect some of your assets. This program is not currently available in every state.
Pre-Existing Conditions: Most Long-Term Care insurance policies cover pre-existing conditions as long as they were disclosed at the time of application.
Respite Care: Temporary care provided to the patient so that the primary informal caregiver can take a break or rest. Respite care can be provided at home or in a facility.
Skilled Nursing Facility/Nursing Home: A health facility that provides 24-hours a day nursing and rehabilitative care on an inpatient basis. A plan of care must be followed and must be ordered by a physician. A registered nurse or LPN must be on duty at all times and a licensed physician must be on call at all times.
Stand-By Assistance: A caregiver is in close proximity to the patient in case the patient needs assistance during the performance of an ADL such as getting out of the shower.
Step-Down: This policy feature allows you to reduce coverage in order to lower your premium by increasing your elimination period, reducing your Daily Benefit, or shortening the coverage period. You can access this feature anytime after the first in-force year of your policy.
Substantial Supervision: Continual monitoring of a cognitively impaired person.
Tax Qualified: In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). This bill confers federal tax advantages on LTC policies that meet the federal guidelines in the Act and are thus designated "tax-qualified" (TQ). Among these advantages is the ability to deduct part of the policy premium from your taxes as a medical expense if you qualify for a medical expense deduction. Also, the insurance benefits you receive are generally not taxable. Policies purchased on or after January 1, 1997 may or may not be tax-qualified. Long-Term Care insurance policies purchased before January 1, 1997 are "grandfathered" and are considered tax-qualified.
Third Party Notice: You can use this benefit to designate a person whom your insurer will notify when your policy is about to lapse due to an unpaid premium.
Toileting: The ability to get on and off the toilet and perform hygiene related tasks.
Transferring: The ability to move in or out of a bed, chair or wheelchair.
Underwriting: During this process, the insurance carrier’s underwriters review the applicant’s medical questionnaire and medical records to determine if they are eligible for coverage. Underwriting for Long Term Care may also involve one or more of the following: a telephone interview by a nurse or health aid including a cognitive test, an in-home physical and cognitive assessment by a nurse or health aide.
WWaiver Of Premium: A common provision in Long-Term Care insurance policies that waives premium payments while the insured is receiving benefits.