A&S: CRITICAL ILLNESS And LTC (till pg67?) Flashcards
Critical Illness (CI) Insurance overview
- a living benefit (pays before death if suffer serious illness + SURVIVE)
- pays lump sum if diagnosed w illness covered in policy + SURVIVES # of days (i.e 30, or wven 90)
- can do whatever want w lump sum (medical, vacation, etc…)
Critical Illness (CI) details
- stand alone product OR as a rider
- anywhere from 10k-2m
Has Qualification period (30 days)
Has waiting (survival) period (30 days)
so 30 days qualification+ 30 days survival = 60 days
CI conditions covered (BIG 4 H.S.H.Cb)
varies
Big 4:
- heart attck
- stroke
- heart bypass
- life threatening cancer
Memory aid: Hear and stroke foundation + BIG C
also:
10 conditions:
20 conditions:
Child CI policy
- benefit is less than adult
- covers same as adults + illnesses more associated with kids
- option to convert to adult plan
RIDERS FOR CRITICAL ILLNESS POLICY (3-R.W.2)
return of premium (similar to Disability)
waiver of premium (similar to disability)
2nd event rider
2nd event rider for CI
- only for CI
- w/o rider: after pay out = CI terminates
- W RIDER: keeps policy in force if has 2nd UNRELATED event, 2nd benefit paid (smaller)
CI exclusions
- same as disabilty insurance (add later)
+
non occ HIV/AIDS: medical practitioner that contracts HIV/AIDS on the job
Long term Care Insurance (LTC)
- covers living in nursing home (up to daily max cost)
LTC benefit triggers
Insured unable to do 2 or more activities of daily living (ADL’S
+
satisfies elimination period (0-90 days)
LTC Activities of dailhy living (ADL’s - 6)
- Transferring: moe around w/o assistance (i.e in/out of a chair)
- Maintain Continence: controlling bladder
- Toileting: get to/from + on/off toilet
- bathe/shower
- Get dressed/undressed
- Feeding self
memory aid: all the things u do to get ready for work in AM (or pm before bed)
LTC: Cognitive Impairment
- can qualify if cognitive impairment (i. e alzheimers)
LTC expenses covered
- homecare w care pro’s visitng patient
- respite care: family member providing care and needs relief temporarily
- Assisted Living: health facility, patient has own private residence
- Nursing Home/LTC facility): if patient nees 24hrs care/supervision
LTC payment models
Indemnity Model: pays LTC provider directly
Reimbursement model: insured pays, , then gets reimbursed
LTC MAX COVERAGE AMOUNTS CALCUATION
daily max X mac benefit period (in care days)
i,e
daily max $400
benefit period: 365 days
so: $400 x 365= $146,000
LTC ODDS/ENDS
EXCLUSIONS: similar to CI policies
COLA + ROP riders can be added
Qualification period
Exclusionary clause that states covered condition rhat is discovered within 30 days of policy ISSUE not covered (may be up to 90 days)
Survival/waiting period
Once diagnosed w covered illness , must SURVIVE min 30 day (or longer for certain conditions)
CI RIDERS
- Return of premium (ROP)
- waiver of premium (WOP)
CI: return of premium (ROP- 3 types DSM)
ROP: pays back some or all of premium paid under certain consitions
3 types ( DSM) on:
- Death reom cause not covered
- Surrender w/o claim
- maturity w/o claim
CI: waiver of premium pg65
- must qualify medically + extra premium
- waiting period: 4-6 months
- waived premium if insured or policy holder (whoever pays) becomes disabled
LTC options pg67
- home care - 1st tier, health care in home
- respite care: relief for caregivers for few hours
- assisted living: for those who cant live independently anymore (not 24hrs)
- nursing home (facility) care : for chronic care, 24 hour nursing care + doctor, prepared meals, etc… )
Individual LTC ins
- usually stand alone policy
- optional rider and life is and CI ins contracts
- NOT disability ins
- to cver costs of care due to illness, injury, aging
- usually ppl age 45-55
- minimizes/eliminates financual burder of ltc services
- elimination period: 0-90 days, shorter = more premium
LTC exclusions
- war
- terrorism
- attempted suicide
- self inflicted injuries
- normal pregnancy
- criminal actiity
- drugs
- AIDS/HIV
LTC Activities of Daily Living (ADL’s)
- insurer uses ADL’s to determine if qualify for LTC
ADL's: - dressing - bathing - toileting - transferring - eating - maintain continence (control bladder) \+ whether insured is cognitively impaired
LTC riders
- Cost of living adj (COLA(
- Return of premium
LTC: COLA rider
- automatically increases maximum benefit amount to keep up w inflation
LTC: return of Premium rider
- when dead, if insured has no claims, premiums returned to fam.
- amount returned varies depemding on how long policy in force
- received tax free
LTC: Policy Benefits
- reimbursement
- indemnity
LTC: policy benefits: reimburserment
- repaying insured after already paid expenses
- amount determined as max/day or per service/equipment
LTC: policy benefits: Indemnity
- insurer pays directly to care provider
