LONG-TERM CARE INSURANCE Flashcards
ACTIVITIES OF DAILY LIVING (ADL)
PHYSICAL FUNCTIONS THAT AN INDEPENDENT PERSON PERFORMS EACH DAY, INCLUDING BATHING, DRESSING, EATING, TRANSFERRING, TOILETING, AND MAINTAINING CONTINENCE
ADULT DAY CARE
SERVICES PROVIDED DURING THE DAY AT A COMMUNITY-BASED CENTER. PROGRAMS ADDRESS THE INDIVIDUAL NEEDS OF FUNCTIONALLY OR COGNITIVELY IMPAIRED ADULTS
ASSISTED LIVING
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
BED RESERVATION
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
CHRONIC ILLNESS
HAVING A PHYSICAL OR COGNITIVE IMPAIRMENT THAT PREVENTS THE INSURED INDIVIDUAL FROM PERFORMING AT LEAST TWO 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
CUSTODIAL CARE
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
EXPENSE INCURRED METHOD
THIS METHOD PROVIDES FOR REIMBURSEMENT OF EXPENSE ONCE BILLS ARE SUBMITTED TO THE INSURANCE COMPANY. THE REIMBURSABLE AMOUNT CANNOT EXCEED THE BENEFIT AMOUNT
GUARANTEED PURCHASE OPTION
ALLOWS THE INSURED TO INCREASE THE BENEFITS BY A STATED PERCENTAGE PERIODICALLY
GUARANTEED RENEWABLE
THE COMPANY MUST RENEW THE POLICY EACH YEAR AS LONG AS THE PREMIUMS ARE PAID
HOME HEALTH CARE
LIMITED PART-TIME OR INTERMITTENT SKILLED NURSING CARE AND HOME HEALTH AIDE SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH-LANGUAGE PATHOLOGY SERVICES, MEDICAL SOCIAL SERVICES, DURABLE MEDICAL EQUIPMENT (SUCH AS WHEELCHAIRS, HOSPITAL BEDS, OXYGEN, AND WALKERS), MEDICAL SUPPLIES, AND OTHER SERVICES PROVIDED IN THE PATIENTS HOME
HOSPICE CARE
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
INFLATION PROTECTION
HELPS THE INSURED TO MAINTAIN THE PURCHASING POWER OF THE ORIGINAL CONTRACT BENEFIT
INTERMEDIATE-CARE NURSING FACILITY
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
LONG-TERM CARE INSURANCE
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
LONG-TERM CARE SERVICES
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
MAXIMUM LIFETIME BENEFIT
THE TOTAL AMOUNT OF MONEY THAT COULD BE PAID UNDER THE LTC POLICY FOR CHARGES INCURRED FOR COVERED SERVICES
MEDICAID
A STATE AND FEDERAL ASSISTANCE PROGRAM THAT PAYS FOR MEDICAL CARE AND MOST LONG-TERM CARE EXPENSES FOR ELIGIBLE PERSONS WITH LOE INCOMES AND LIMITED ASSETS
MEDICARE
A FEDERAL PROGRAM THAT PAYS FOR HEALTHCARE FOR PERSONS 65 AND OVER AND FOR PEOPLE UNDER AGE 65 WITH DISABILITIES
MENTAL AND NERVOUS DISORDERS
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, ALZHEIMERS 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 CONDITIONS
NON-FOREFEITURE BENEFIT
THE INSURER MUST GUARANTEE THAT THE INSURED WILL RECEIVE SOME OF THE BENEFITS PAID FOR EVEN UPON CANCELLATION OR LAPSE OF COVERAGE
PRE-EXISTING CONDITIONS
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
REFUND OF PREMIUM
THE COMPANY WILL REFUND SOME OR ALL OF THE INSUREDS PREMIUMS MINUS ANY CLAIMS PAID UNDER THE POLICY IF THE POLICY IS CANCELED. THE INSUREDS BENEFICIARY WILL RECIEVE SUCH REFUND IF THE INSURED DIES
RESTORATION OF BENEFITS
SOME POLICIES RESTORE BENEFITS TO THE ORIGINAL MAXIMUM AMOUNTS IF THE INSURED NO LONGER NEEDS LONG-TERM CARE SERVICES, USUALLY AFTER 180 DAYS
SHARED BENEFITS
POLICES 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 SPOUSES POLICY
SKILLED CARE FACILITY
24-HOUR NURSING CARE FOR CHRONICALL-ILL OR SHORT-TERM REHABILITATIVE RESIDENTS OF ALL AGES. IT PROVIDES THE HIGHEST LEVEL OF SERVICE, AND COMBINES DAILY MEDICAL AND CUSTODIAL CARE
SPECIAL NEEDS TRUST
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
TERMINAL ILLNESS
HAVING A LIFE EXPECTANCY OF LESS THAN 24 MONTHS, WHICH MUST BE CERTIFIED BY A QUALIFIED HEALTH PROFESSIONAL
TOTAL PLAN BENEFIT
THE TOTAL AMOUNT OF MONEY THAT COULD BE PAID UNDER THE LTC POLICY FOR CHARGES INCURRED FOR COVERED SERVICES
TRADITIONAL MEDICAL CARE
ATTEMPTS TO TREAT OR CURE ILLNESSES
WAIVER OF PREMIUM
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 HOME HEALTHCARE
