Long-Term Care Flashcards
Long term care insurance
includes any insurance policy, certificate or rider that provided coverage for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services that are provided in a setting other than an acute care unit of a hospital.
What are the standard levels of care?
Skilled nursing care
Intermediate nursing care
Home health care and community based care
Custodial care
Skilled care
Skilled care is daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician. It is almost always provided in an institutional setting.
Intermediate care
Is occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care. It is ordered by a physician and skilled medical personnel would deliver or monitor this type of care. It can be carried out in a nursing home, an intermediate care unit or in the patients home.
Custodial care
Is care for meeting personal needs such as assistance with eating, bathing, or dressing, which can be provided by non medical personnel, such as relatives or home care workers. It can be provided in an institutional setting or in the patients home.
Personal care
Included hands-on services to assist an individual with activities of daily living, and can be provided by a skilled or unskilled person.
What 8 facilities offer LTC services? Where are they generally provided at?
Nursing home care: is usually provided as one of these: skilled nursing care, intermediate nursing care, custodial care
Assisted living: offers help with non medical aspects of daily activities in an atmosphere of separate, private living units.
Residential care facilities: is provided while the insured resides in a retirement community or a residential care facility for the elderly.
Home setting: home health care is care provided by a skilled nursing or other professional services in one’s home. It includes occasional visits to the persons home by all nurses or community based organizations like hospice.
Home Care: policies with benefits limited to home care services must be clearly labeled home care only on the policy first page
Hospice: is a facility that provides short-term, continuous care in a home-like setting to terminally ill people with 6 months or less life expectancy
Respite Care: is designed to provide relief to the family of the caregiver
Adult day care: is care provided for functionally impaired adults on less than a 24-hour notice
The following are prohibited provisions for LTC insurance policies in CA
Canceling or failing to renew due to changes in a persons health
Having the premium increased in the event of a divorce
Limiting benefits to skilled nursing facilities only
Living benefits are
You can purchase a living benefits policy rider to advance a life insurance policy. Living benefit riders agree to pay a part of the policy death benefit to insureds in order to pay for long term care or nursing home care. The advanced is treated as a lien against death benefit of the policy.
LTC policies are guaranteed renewable, however the insurers do have the right to…
Increase the premiums
How many hours of Long term care training and education are needed after you receive your license?
8 hours annually for the first 4 years after the original license is issued
How long is training and education for LTC after the first 4 years?
8 hours of training every 2 year license term thereafter.
When long term care coverage is being replaced, the sales commission that is paid by the insurer and that represents the % of the sale normally paid for the 1st year sales of the policy will be calculated based on what?
The difference between the annual premium of the replacement coverage and that of the original coverage
Do Medicare and medigap policies cover long term custodial or nursing home care?
No they do not.
Does Medicare cover nursing home care?
Yes, if it’s part of a treatment for a covered injury or illness
