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2021 NYS Life and Health > Chapter 15 - Long-Term Care Insurance > Flashcards

Chapter 15 - Long-Term Care Insurance Flashcards

1
Q

What services are provided under the long-term care’s assisted living care? (6)

A
  • Providing Meals
  • Transportation for medical appointments, activities, and pleasure trips
  • Linens and personal laundry services
  • Assistance with dressing and bathing
  • Reminder regarding medication
  • Assistance with eating
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2
Q

What is intermediate care? (5)

A
  • Occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care
  • Ordered by a physician
  • Skilled medical personnel would deliver or monitor this type of care.
  • May be carried out in a nursing home, an intermediate-care unit or in the patient’s home.
  • Examples - Giving medication to a group in physical therapy or changing a bandage.
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3
Q

What is Assisted Living?

A

Help with nonmedical aspects of daily activities in an atmosphere of a separate, private living unit.

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4
Q

Long-term care policies must provide coverage in a setting other than an acute care unit of a hospital of at least how long?

A

12 consecutive months

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5
Q

When would Medicare cover nursing home care?

A

If it is part of the treatment for a covered injury or illness.

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6
Q

Long-term care needed because of aging is not covered by what? (2)

A
  • Medicare

- Medicare supplements

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7
Q

Medicaid provides nursing home care coverage for who?

A

Those that qualify with low income and low assets.

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8
Q

What are the three levels of care?

A
  1. Skilled Care
  2. Intermediate Care
  3. Custodial care
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9
Q

In addition to the three levels of coverage, long-term care policies will generally cover what else?

A
  • Home health care
  • Adult day care
  • Hospice Care
  • Respite Care
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10
Q

What are the activities of daily living? (6)

A
  • Bathing
  • Dressing
  • Toileting
  • Transferring positions/mobility
  • Continence
  • Eating
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11
Q

What is skilled care? (3)

A
  • Daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician.
  • Almost always provided in an institutional setting
  • Examples: Changing sterile dressing & physical therapy
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12
Q

Care that can be given by nonprofessional staff is not considered what?

A

Skilled Care

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13
Q

What is custodial care? (3)

A
  • Care for meeting personal needs such as assistance in eating, dressing, or bathing (not hospital or surgical needs)
  • Can be provided by nonmedical personnel
  • Can be provided in an institutional setting or in the patient’s home
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14
Q

What is home health care? (3)

A
  • Care provided by a skilled nurse or other professional services in one’s home.
  • Includes occasional visits to the person’s home by registered nurses, licensed practical nurses, licensed vocational nurses, or community-based organizations like hospice.
  • Might include physical therapy, occupational therapy, speech therapy, and medical services by a social worker.
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15
Q

What is adult daycare? (3)

A
  • Care provided for functionally impaired adults on less than a 24-hour basis.
  • Could be provided by a neighborhood recreation center or a community center.
  • Care includes transportation to and from the daycare center, and a variety of health, social and related activities. Meals are usually included as part of the service.
  • They provide respite care for the caregiver
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16
Q

What is Respite Care?

A
  • Designed to provide relief to the family caregiver

- Can include a service such as someone coming to the home while the caregiver takes a nap or goes out for a while.

17
Q

What is the usual range of elimination periods for a long-term care policy?

A

0 to 365 days

18
Q

What is the usual range of benefit periods for a long-term care policy?

A

2 to 5 years

19
Q

_______ is a method of paying benefits to insureds based on a predetermined, fixed rate set for the service provided, regardless of the actual benefit paid.

A

INDEMNITY is a method of paying benefits to insureds based on a predetermined, fixed rate set for the service provided, regardless of the actual benefit paid.

20
Q

What are some common optional benefits available for long-term care policies? (4)

A
  1. Inflation Protection
  2. Nonforfeiture Benefit
  3. Guarantee of Insurability
  4. Return of Premium
21
Q

What is required of Inflation Protection for Long-Term Care policies in New York State?

A

All LTC policies must offer each policyholder an inflation protection feature that provides, as a minimum, one of the following benefits:

  • Increase of 5% for the annual benefit level
  • The right of the insured to periodically increase benefit levels without providing evidence of insurability or health status (as long as the option has not been declined for 3 consecutive times)
  • Coverage for a specified percentage of actual or reasonable charges.
22
Q

What are nonforfeiture (default or lapse) benefits? (3)

A
  • Must be offered to the applicant in NYS
  • These forfeiture values, such as produced paid-up insurance, may apply to nursing home benefits or to all benefits provided by the policy.
  • The offer may be in the form of a rider that is attached to the policy.
23
Q

What does the Guarantee of Insurability option do? (2)

A
  • Allows the insured to periodically increase the benefit levels without providing evidence of insurability.
  • The amount is usually limited to allowing a 5% compounded annual increase.
24
Q

What does the return of premium option do?

A

This optional nonforfeiture type benefit is offered by most insurers so that in the event the insured dies or the policy is lapsed, the insurer will return a certain percentage of the premiums paid.

25
Q

What is a shared care policy?

A
  • Type of LTC policy in which the couples pool the benefits of 2 LTC policies and splits them.
  • Ex: Rather than each person buying a 5-year LTC policy, they have 10 years total to use between them.
26
Q

Today LTC coverage is marketed in what formats?

A
  1. Individual Policies
  2. Group policies
  3. Associations
27
Q

What are long-term care riders on life insurance?

A
  • Provide payment of part of the death benefit (accelerated benefits) in order to take care of the insured’s health care expenses. which are incurred in a nursing or convalescent home.
  • Payment of LTC benefits will reduce the amount payable to the beneficiary upon the insured’s death.
28
Q

What is a hybrid policy? (4)

A
  • Combines whole life insurance and some LTC coverage into a single policy.
  • LTC component protects financial assets from being drained by LTC expenses
  • Whole life insurance component adds an important retirement asset and fund for the beneficiary.
  • May also combine LTC coverage with an annuity which allows the insured to receive a guaranteed payment sometime in the future while still living.
29
Q

LTC policies may have what exclusions? (5)

A
  1. Pre-existing conditions or diseases
  2. Mental and nervous disorders or disease (except for organic cognitive disorders such as Alzheimer’s disease, senile dementia, and Parkinson’s disease)
  3. Alcoholism and drug addiction
  4. Treatment or illness caused by war, participation in criminal activities, or attempted suicide, and
  5. Treatment payable by the government, Medicare, workers compensation or similar coverage
30
Q

Before a LTC policy will be issued to an applicant 80 or older, the insurer must obtain what? (4)

A
  1. A report of a physical examination
  2. As assessment of functional capacity
  3. An attending physician’s statement
  4. Copies of medical records
31
Q

What provisions are required in LTC policies in NYS? (6)

A
  1. Must be guaranteed renewable
  2. Must offer inflation protection
  3. Free look period - 30 day
  4. Pre-existing conditions exclusion - no more than 6 months
  5. Must cover Alzheimer’s disease
  6. Disclosure requirements - outline of coverage and policy summary

2021 NYS Life and Health (18 decks)

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