A&S: CRITICAL ILLNESS And LTC (till pg67?)

Question 1

Critical Illness (CI) Insurance overview

Answer 1

• 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…)

Question 2

Critical Illness (CI) details

Answer 2

• 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

Question 3

CI conditions covered (BIG 4 H.S.H.Cb)

Answer 3

varies

Big 4:

• heart attck
• stroke
• heart bypass
• life threatening cancer

Memory aid: Hear and stroke foundation + BIG C

also:
10 conditions:

20 conditions:

Question 4

Child CI policy

Answer 4

• benefit is less than adult
• covers same as adults + illnesses more associated with kids
• option to convert to adult plan

Question 5

RIDERS FOR CRITICAL ILLNESS POLICY (3-R.W.2)

Answer 5

return of premium (similar to Disability)
waiver of premium (similar to disability)
2nd event rider

Question 6

2nd event rider for CI

Answer 6

• 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)

Question 7

CI exclusions

Answer 7

• same as disabilty insurance (add later)
  +
  non occ HIV/AIDS: medical practitioner that contracts HIV/AIDS on the job

Question 8

Long term Care Insurance (LTC)

Answer 8

• covers living in nursing home (up to daily max cost)

Question 9

LTC benefit triggers

Answer 9

Insured unable to do 2 or more activities of daily living (ADL’S
+
satisfies elimination period (0-90 days)

Question 10

LTC Activities of dailhy living (ADL’s - 6)

Answer 10

1. Transferring: moe around w/o assistance (i.e in/out of a chair)
2. Maintain Continence: controlling bladder
3. Toileting: get to/from + on/off toilet
4. bathe/shower
5. Get dressed/undressed
6. Feeding self

memory aid: all the things u do to get ready for work in AM (or pm before bed)

Question 11

LTC: Cognitive Impairment

Answer 11

• can qualify if cognitive impairment (i. e alzheimers)

Question 12

LTC expenses covered

Answer 12

• 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

Question 13

LTC payment models

Answer 13

Indemnity Model: pays LTC provider directly

Reimbursement model: insured pays, , then gets reimbursed

Question 14

LTC MAX COVERAGE AMOUNTS CALCUATION

Answer 14

daily max X mac benefit period (in care days)

i,e
daily max $400
benefit period: 365 days
so: $400 x 365= $146,000

Question 15

LTC ODDS/ENDS

Answer 15

EXCLUSIONS: similar to CI policies

COLA + ROP riders can be added

Question 16

Qualification period

Answer 16

Exclusionary clause that states covered condition rhat is discovered within 30 days of policy ISSUE not covered (may be up to 90 days)

Question 17

Survival/waiting period

Answer 17

Once diagnosed w covered illness , must SURVIVE min 30 day (or longer for certain conditions)

Question 18

CI RIDERS

Answer 18

• Return of premium (ROP)

- waiver of premium (WOP)

Question 19

CI: return of premium (ROP- 3 types DSM)

Answer 19

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

Question 20

CI: waiver of premium pg65

Answer 20

• must qualify medically + extra premium
• waiting period: 4-6 months
• waived premium if insured or policy holder (whoever pays) becomes disabled

Question 21

LTC options pg67

Answer 21

• 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… )

Question 22

Individual LTC ins

Answer 22

• 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

Question 23

LTC exclusions

Answer 23

• war
• terrorism
• attempted suicide
• self inflicted injuries
• normal pregnancy
• criminal actiity
• drugs
• AIDS/HIV

Question 24

LTC Activities of Daily Living (ADL’s)

Answer 24

• 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

Question 25

LTC riders

Answer 25

• Cost of living adj (COLA(

- Return of premium

Question 26

LTC: COLA rider

Answer 26

• automatically increases maximum benefit amount to keep up w inflation

Question 27

LTC: return of Premium rider

Answer 27

• when dead, if insured has no claims, premiums returned to fam.
• amount returned varies depemding on how long policy in force
• received tax free

Question 28

LTC: Policy Benefits

Answer 28

• reimbursement

- indemnity

Question 29

LTC: policy benefits: reimburserment

Answer 29

• repaying insured after already paid expenses

- amount determined as max/day or per service/equipment

Question 30

LTC: policy benefits: Indemnity

Answer 30

• insurer pays directly to care provider