Chapter 7: Vocab

Question 1

activities of daily living (ADL)

Answer 1

physical functions that an independent person performs each day, including bathing, dressing, eating, transferring, toileting, and maintaining continence

Question 2

adult day care

Answer 2

services provided during the day at a community based center. programs address the individual needs of functionally or cognitively impaired adults

Question 3

assisted living

Answer 3

senior housing that provides individual apartments, which may or may not have a kitchenette. facilities offer 24 hour on site staff, congregate dining, and activity programs. limited nursing services may be provided for an additional fee

Question 4

bed reservation

Answer 4

some policies will pay to reserve a bed in the nursing home when the insured leaves to go into a hospital. this reservation can last a specified number of days or until the insured returns from the hospital

Question 5

chronic illness

Answer 5

having a physical or cognitive impairment that prevents the insured individual from performing at least tow of the six activities of daily living for at least a 90 day period, or requiring substantial supervision to prevent the insured from posing a danger to himself, herself, or others

Question 6

custodial care

Answer 6

board, room and other personal assistance services (including assistance with activities of daily living, taking medicine and similar personal needs) that may not include a skilled nursing care component

Question 7

expense incurred method

Answer 7

this method provides for reimbursement of expense once bills are submitted to the insurance company. the reimbursable amount cannot exceed the benefit amount

Question 8

guaranteed purchase option

Answer 8

allows the insured to increase the benefits by a stated % periodically

Question 9

guaranteed renewable

Answer 9

the company must renew the policy each year as long as premiums are paid

Question 10

home health care

Answer 10

limited part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, SLP services, medical social services, durable medical equipment (wheelchairs, beds, oxygen) medical supplies, and other services provided in the patient’s home

Question 11

hospice care

Answer 11

offers a special way of caring for people who are terminally ill, typically utilizing a team oriented approach to address medical, physical, social, emotional, and spiritual needs

Question 12

inflation protection

Answer 12

helps the insured to maintain the purchasing power of the original contract benefit

Question 13

intermediate-care nursing facility

Answer 13

a licensed facility with the primary purpose of providing health or rehabilitative services. typically provides custodial care along with intermittent, as opposed to daily medical care

Question 14

long-term care insurance

Answer 14

coverage that pays for all or part of the cost of home health care services or care in a nursing home or assisted living facility

Question 15

long term care services

Answer 15

medical and non-medical care for people with chronic illnesses or disabilities that assists people with activities of daily living, such as dressing, bathing, and using the bathroom. long-term care can be provided at home, in the community, or in a facility

Question 16

maximum lifetime benefit

Answer 16

the total amount of money that could be paid under a ltc policy for charges incurred for covered services

Question 17

medicaid

Answer 17

a state and federal assistance program that pays for medical care and most long-term care expenses for eligible persons with low incomes and limited assets

Question 18

medicare

Answer 18

a federal program that pays for healthcare for persons age 65 and over and for people under age 65 with disabilities

Question 19

mental and nervous disorders

Answer 19

long-term care insurance policies can exclude coverage of some mental and nervous disorders, but the policy must cover serious biologically-based mental illnesses and other diseases, such as schizophrenia, major depression disorders, Alzheimer’s disease, and other age-related disorders. However, a long-term care insurer may refuse to sell a policy to someone already suffering from these otherwise covered conditionos.

Question 20

non-forfeiture benefit

Answer 20

the insurer must guarantee that the insured will receive some of the benefits paid for even upon cancellation or lapse of coverage

Question 21

pre-existiing conditions

Answer 21

a pre-existing condition is an illness or disability for which an insured has received previous medical advice or treatment usually within six months prior to the application for long-term care coverage

Question 22

refund of premium

Answer 22

the company will refund some or all of the insured’s premium minus any claims paid under the policy if the policy is canceled. The insured’s beneficiary will receive such refund if the insured dies

Question 23

restoration of benefits

Answer 23

some policies restore benefits to the original maximum amounts if the insured no longer needs long-term care services, usually after 180 days

Question 24

shared benefits

Answer 24

policies that have this benefit permit a person who has fully exhausted the benefits under his or her own policy to make use of the benefits available under his or her spouse’s policy

Question 25

skilled care facility

Answer 25

24 hour nursing care for chronically-ill or short term rehabilitative residents of all ages. It provides the highest level of service, and combines daily medical and custodial care

Question 26

special needs trust

Answer 26

a specific type of trust that is used to provide benefits to persons or beneficiaries with special needs. They are designed to protect eligibility for government assistance programs while improving the life of the beneficiary

Question 27

terminal illness

Answer 27

having a life expectancy of less than 24 months, which must be certified by a qualified health professional

Question 28

total plan benefit

Answer 28

the total amount of money that could be paid under the LTC policy for charges incurred for covered services

Question 29

traditional medical care

Answer 29

attempts to treat or cure illnesses

Question 30

waiver of premium

Answer 30

allows the insured to stop paying premiums during the period in which he or she is receiving policy benefits. However, this provision may only apply to certain benefits, for example, nursing home or health care