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LTC Terms > LTC Deck > Flashcards

LTC Deck Flashcards

1
Q

A life insurance policy feature that lets the policyholder use some of the policy’s death benefit before he or she dies.

A

Accelerated Death Benefit

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2
Q

AUS - AUS Acceptable Use Standard

A

The parameters that govern access to, and use of, LTCG information and communications systems. The AUS outlines general requirements, illustrative examples of inappropriate or prohibited activities, notice of LTCG’s explicit right to monitor use of company resources, and outlines potential ramifications resulting from the violation of this policy. Regardless of whether the User is accessing and using the system for business or personal use, Users must strictly adhere to the directives and guidelines provided within this AUS.

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3
Q

ACL - Access Control List

A

A security technology that is used to permit or deny network traffic flow.

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4
Q

Ack Call - Acknowledgement Call

A

During intake, the process in which LTCG validates the request for a claim to be filed for long term care insurance benefits.

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5
Q

ABAT - Active Batch

A

Workload automation and job scheduling system that integrates business applications, stand-alone tasks, processes and scripts across different computing environments to give the user a centralized view of operations at the project, organizational or enterprise level. It functions to eliminate wait or idle time in existing workflows and reduce manual error.

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6
Q

ADC Active Directory Controller

A

A server running Active Directory Domain Service (AD DS) is called a domain controller. It authenticates and authorizes all users and computers in a Windows domain type network—assigning and enforcing security policies for all computers and installing or updating software. For example, when a user logs into a computer that is part of a Windows domain, Active Directory checks the submitted password and determines whether the user is a system administrator or normal user. Also, it allows management and storage of information, provides authentication and authorization mechanisms, and establishes a framework to deploy other related services: Certificate Services, Active Directory Federation Services, Lightweight Directory Services and Rights Management Services.

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7
Q

ALR - Active Life Reserve

A

ALR Active Life Reserve LTC carriers must set aside most of the premiums collected for future claims.

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8
Q

ADL - Activity of Daily Living

A

ADL Activity of Daily Living Basic activities that a person must be able to perform to take care of themselves. Bathing (B), eating (E), dressing (D), toileting (Tlt), transferring (Tr), continence (C or Cntc), ambulation (Amb) and mobility (M) are the most common ADLs used to qualify for long term care insurance benefits.
Bathing. Washing oneself by sponge bath, or in either a tub or shower. This ADL also includes the task of getting into or out of the tub or shower.
Continence. The ability to maintain control of bowel and bladder function, or when unable to maintain control of these functions, the ability to perform associated personal hygiene (including caring for a catheter or colostomy bag).
Dressing. Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs. Dressing includes the ability to get to and from the closet or dresser and obtain clothing.
Eating. Feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously. Eating does not mean preparing the food to be consumed.
Mobility/Ambulation. Moving about either/both inside and outside the residence; policies will differ as to whether this is evaluated using or not using an assistive device.
Toileting. Getting to and from, and on and off the toilet, and performing associated personal hygiene.
Transferring. Moving into and out of a bed, chair or wheelchair.

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9
Q

ADS - Actuarial Data Store

A

A set of data views that LTCG creates, from which a limited subset is turned into text files that are sent to a client.

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10
Q

Acute Care

A

Usually short term, this is the kind of care that has recovery as its primary goal. It usually requires the services of a physician, nurse, or other skilled health care professional and it is typically provided in a doctor’s office or a hospital.

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11
Q

ACLF - Adult Congregate Living Facility

A

A facility that operates like an Assisted Living Facility (ALF) or similar residential care community, but may provide a smaller range of services than licensed ALFs, such as assistance with few ADLs and may not provide medication administration services. ACLFs do not exist in all states.

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12
Q

ADC - Adult Day Care

A

Day program (i.e., no overnight care) which offers supervision, socialization, activities and personal care services to persons with ADL deficits and/or require supervision due to dementia, but typically no more than minimal skilled nursing care. Most provide 2-3 meals per day, as well as transportation. Many are affiliated with churches or part of community centers, serve from a small handful to a few dozen persons and operate under either a social model or medical model.

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13
Q

Adult Day Health Care

A

Day program (i.e., no overnight care) which offers supervision, socialization, activities and personal care services to persons with ADL deficits and/or require supervision due to dementia, but typically no more than minimal skilled nursing care. Most provide 2-3 meals per day, as well as transportation. Many are affiliated with churches or part of community centers, serve from a small handful to a few dozen persons and operate under either a social model or medical model.

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14
Q

Age Banding

A

In Resol, age banding refers to the ability to define a specific percentage rate increase based on a policyholder’s issue or attained age within the same rate increase offer. For example, increase rates by x% for policyholders with an issue age of 0-59, y% for policyholders with an issue age of 60-69, and z% for policyholders with an issue age of 70+.

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15
Q

Age Based Payer Model

A

The contribution method used to define this payer model is expressed as core premium that varies by age

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16
Q

AGT or Agent

A

One who is authorized to act for or in the place of another as a representative.

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17
Q

AMS - Agent Management System

A

For MetLife to do self-serve data entry related to the management of their agents on LTCG’s system.

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18
Q

Agent Prescreen

A

Module in CLTCAS

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19
Q

Agent Resource Center

A

Transamerica’s Long Term Care distribution web portal. Utilized by agents and offices. They can get updates on underwriting status, get marketing materials, training materials, run illustrations, and submit eApplications

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20
Q

AltaVault

A

NetApp® AltaVault® cloud-integrated storage enables customers to securely back up data to any cloud at up to 90% lower cost compared with on-premises solutions. AltaVault gives customers the power to tap into cloud economics while preserving investments in existing backup infrastructure and meeting backup and recovery SLAs

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21
Q

A&O - Alert and Oriented

A

Clinical shorthand for the findings in a physical examination of the patient by a healthcare worker, referring to a patient who is responsive to his or her environment (alert), and knows who he or she is, where he or she is, and the approximate date, day and time

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22
Q

ACF - Alternate Care Facility

A

A facility which provides long term care services and which doesn’t meet plan requirements for long term care facilities specified in the policy, such as Nursing Home, Assisted Living Facility or Long Term Care Facility. The reasons an Alternate Care Facility may not satisfy policy requirements may include staffing, bed size and/or provision of nursing care services. Coverage of an Alternate Care Facility is usually subject to approval by the insurer. The insurer may delegate the authority to LTCG to make decisions to approve or deny coverage of an Alternate Care Facility under guidelines the insurer approves.

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23
Q

ASAP - Alternative Simplified Application Process

A

This is a term for the application for insurance that prospective policyholders must fill out before they are underwritten and approved for a new policy

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24
Q

American Fidelity and American General and AmGen

A

Clients

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25
Q

AICPA - American Institute of Certified Public Accountants

A

The national professional organization of Certified Public Accountants (CPAs) in the US, with more than 418,000 members in 143 countries in business and industry, public practice, government, education, student affiliates and international associates. It sets ethical standards for the profession and U.S. auditing standards for audits of private companies, non-profit organizations, federal, state and local governments

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26
Q

AML - Anti-Money Laundering

A

A set of laws, regulations, and procedures intended to prevent criminals from disguising illegally obtained funds as legitimate income

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27
Q

APP - Application

A

A form on which the prospective insured states facts requested by the insurer on the basis of which, together with information from other sources, the insurer decides whether to accept the risk, modify the coverage offered or decline the risk

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28
Q

AC - Application Control (Previously referred to as Enrollment Processing)

A

A department within LTCG that manages the process of entering and quality review of new business applications into our Enrollment Processing system. This consists of assigning a policy number, reviewing the application for completeness, identifying and requesting missing application pages or questions, and validating agent licensing. Previously referred to as Enrollment Processing

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29
Q

ALM - Application Lifecycle Management

A

A practice for managing the configuration, build, and deployment of software. Synonymous with DevOps and Software Configuration management (SCM).

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30
Q

ADD - Architecture Definition Document

A

A way for system architecture to be documented.

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31
Q

AS or ASM - Assessment Services

A

LTCG performs health assessment services for more than 60 different clients. Assessments are for evaluation for insurability for underwriting, evaluation of claimants’ ability to perform ADLs or need for supervision due to cognitive impairment or in connection with the LIFT program. Assessments can be in person or telephonic. Most will include a cognitive assessment

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32
Q

LINK - Assessments Application

A

Link is LTCG’s proprietary operating and workflow management system for assessments. Link is a paperless system. It provides work queues for staff to work from, assessment orders are integrated into Link, Telephonic assessments are completed in Link and the output is sent from Link to the customers. In-home assessments are sent to field nurses to be completed from Link. The in-home completed assessment is received back into Link reviewed internally and sent to the carrier

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33
Q

AOB - Assignment of Benefit

A

An arrangement by which an insured can request that their care providers (e.g., home care agency or nursing home) are paid directly by the insurer, rather than having the program reimburse members for expenses they incur after they pay the provider. Each claimant and their provider decide whether they want to have this Assignment of Benefits and they can also change their mind at any time.

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34
Q

ALF - Assisted Living Facility

A

A residential living facility which provides individualized care and health services to residents who need assistance with Activities of Daily Living, supervision for safety and, if structured appropriately, limited nursing care. ALFs are governed by the states in which they operate under a range of names, including but not limited to Custodial Care, Domiciliary Care, Intermediate Care, Personal Care, Residential Care Facilities/Residential Care Facilities for the Elderly, Sheltered Care, Supported Care Facilities, Supportive Living, Board and Care, Adult Foster Care, Enriched Housing (NY), Housing with Services (MN). ALFs range in size from converted private homes to large, multi-level (independent, assisted, skilled, memory care) communities. While some people choose to live in this type of a facility before they may need this type of help, many people move to this type of facility when they require some assistance with more than one or more of the activities of daily living, but do not require the level of care provided in a nursing home.

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35
Q

Attained Age

A

The age of the insured when a coverage change is executed.

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36
Q

APS or APR - Attending Physicians Statement / Report

A

A broad term describing information about a person’s medical history, medications and current clinical status solicited from a physician for the purpose of underwriting risk at the time of application or evaluating claimant eligibility. For underwriting purposes, three to five years of medical records may also be requested by LTCG

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37
Q

AAA - Authentication Access and Administration

A

Home-grown identity management tool where roles and access are stored; home grown apps use AAA

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38
Q

ACH - Automated Clearinghouse

A

An electronic funds-transfer system that facilitates payments in the U.S. The ACH is run by the National Automated Clearing House Association (NACHA).

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39
Q

Auth - Authorization

A

A device by which one can get a person’s permission to release their health, medical or coverage information to another provider, individual or organization, such as LTCG.

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40
Q

AFE - Authorization for Expenditure

A

Process where the user submits a request for procurement or renewal of a software/hardware/service and the VMO team tracks and manages the budgetary, architectural, and overall need justification for the purchase

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41
Q

Auth Ind - Authorized Individual

A

Any person who has been designated by written notice from the insured or the insured’s legal representative to act in a limited capacity on behalf of the insured in the matter of their long term care insurance coverage

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42
Q

Auto Assign

A

A process used in Assessment Services to offer in home assessment work to their network of contracted nurses through email. The nurse can accept or decline the assessment on the Connect website. If accepted, the assessment paperwork is then sent to the nurse automatically in the preferred mode of the nurse (fax, via Connect, or on Cell Trak).

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43
Q

Auto-Adjudication

A

The automated process used by LTCG on behalf of its claims clients to determine if a request for reimbursement will be paid, denied, or requires additional review before payment or denial by a Claims Examiner. The process is supported by a “rules engine” system – SMARTS. The rules are defined by the business and implemented using the rules engine. Examples of rules that are implemented relate to evaluating service dates, benefit eligibility, type of service(s) received and policy coverage.

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44
Q

AutoAPS

A

Vendor used for legacy LifePlan’s (former name of LTCG’s Assessment Services organization) administration clients for medical records retrieval

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45
Q

ARR or AARR - Automated Agents Request Report

A

Type of typical report that is generated and given to LTCG’s clients.

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46
Q

AWD - Automated Work Distributor

A

This is a common workflow system that queues work tasks and stores images for processing departments. LTCG uses AWD for those clients whose claims are not processed in LTCAS, eLTCAS or CLTCAS.

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47
Q

AAPB Automatic Additional Purchase Benefit

A

Some LTC products offer a rider to allow additional benefits to be purchased, at specified intervals, after the issue date of a policy

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48
Q

ABI - Automatic Benefit Increase

A

Some LTC products offer a rider to allow additional benefits to be purchased, at specified intervals, after the issue date of a policy

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49
Q

ACD - Automated Call Distribution

A

Telephony device that answers and distributes incoming calls to a specific group of terminals or agents within an organization.

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50
Q

Automatic Inflation Protection

A

Policy provision or rider whereby someone elects to purchase automatic inflation protection. Generally, this provision will automatically increase the policy’s benefits annually at a pre-determined rate with no increase in premiums and is typically offered as a Simple Inflation or Compound Inflation benefit feature increasing 5% annually

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51
Q

BAM Dashboard

A

The ability for the BAM activity data to be displayed on a dashboard. There are 2 versions of this for LTCG. One version is for eAPP and the other version is for eLTCAS also called BAMBI using PowerBI (a Microsoft technology).

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52
Q

Base Unit

A

Base Unit is equal to the Maximum Daily Benefit (MDB) or the Maximum Benefit Amount (MBA).

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53
Q

Base Unit Days

A

Base Unit Days is equal to 1 if Base Unit is an MDB and 30 if the Base Unit is MBA.

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54
Q

BD

A

Beginning Date

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55
Q

BAV - Benefit Account Value

A

On LTC insurance policies there are several independent annual and lifetime benefit limits that are reimbursable. This represents the remaining reimbursable value of a benefit.

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56
Q

BA or BEA

A

Benefit Assessment or BEA (benefit eligibility Assesment)

Comprehensive in-person evaluation of a claimant’s functional (ability to perform ADLs) and cognitive status, current medications and brief medical history. BEAs are used by LTCG to assist in the determination of a claimant’s eligibility for benefits.

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57
Q

Benefit Duration

A

The number of days used to select the correct Rate Vector or Duration Band. LTM/(Base Unit/Base Unit Days). This value is rounded to the nearest integer. For example, LTM= $200,000 and MDB=$150 (or $4,500 MBA) 1,333 days.

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58
Q

BERA - Benefit Eligibility Reassessment

A

Comprehensive in-person evaluation of a claimant’s functional (ability to perform ADLs) and cognitive status, current medications and brief medical history. BEAs are used by LTCG to assist in the determination of a claimant’s eligibility for benefits.

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59
Q

BIO - Benefit Increase Option

A

A form of inflation protection where an individual has the right to increase benefits periodically (e.g., every year or every 3 years) to reflect increases in the cost of care. These increases can be elected without providing evidence of insurability (also called proof of good health) as long as the individual is not receiving benefits at the time. The cost for the additional benefit amount is based on the individual’s age at the time they elect to make the increase. Most carriers offer BIOs every two, three, or five years. The typical offer is 5% simple/compound inflation of the policy’s present daily benefit amount or a guaranteed buy-up (e.g., $10) of coverage. After the BIO execution, the policyholder remains on the same plan, but the daily benefit and lifetime maximum amount is increased.

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60
Q

Benefit Period

A

Not common to most LTC policies, this refers to the period of time benefits will be paid or which must pass before a new period begins. A Benefit Period may define a maximum benefit amount or the period after which a new Elimination Period must be met

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61
Q

Benefit Period Banding

A

In Resol, benefit period banding refers to the ability to define a specific percentage rate increase based on a policyholder’s benefit period or lifetime maximum amount within the same rate increase offer. For example, increase rates by x% for policyholders with a 3-year benefit period, y% for policyholders with a 5-year benefit period, and z% for policyholders with a 7 year benefit period.

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62
Q

Benefit Triggers

A

The criteria that must be met to establish an individual’s eligibility for benefits. This is usually based upon limitations in the ability to perform ADLs or because of a need for supervision due to having a severe cognitive impairment.

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63
Q

BEN or Benefits

A

The benefit payment, which may be reimbursement for expenses incurred or cash payments not dependent upon the receipt of covered services issued according to the terms and conditions of the claimant’s long term care policy. Benefits can be paid directly to the individual (for costs they have incurred for their care), or their care providers can be paid directly through an Assignment of Benefits.

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64
Q

B&C Billion and Collections

A

Module in CAS

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65
Q

Billing Mode

A

A designation and frequency of how premium payments are made.

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66
Q

B&D Black and Decker

A

Aetna Group client

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67
Q

Blended Rate Calculation

A

Blended Rate Calculation A blended rate is typically applied to a policy’s premium as a result of a coverage increase/change in coverage. This involves a formula that blends the premium of the old coverage and new coverage in order to credit the policyholder for having previous coverage at a younger age. Clients can elect to customize the blended rate calculation formula. (POS RAD – Cov Change Rules Appendix D). LTCG’s standard blended rate formula (one of two options):
A = Premium for new coverage at attained age
B = Premium for previous coverage at attained age
C = Premium for previous coverage at original age (Option 2 – …at previous age)
D = Premium credit (B – C)
E = The blended premium for the “new” coverage (A – D = E)

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68
Q

BGP Border Gateway Protocol

A

Border Gateway Protocol (BGP) is a standardized exterior gateway protocol designed to exchange routing and reachability information among autonomous systems (AS) on the Internet. The Border Gateway Protocol makes routing decisions based on paths, network policies, or rule-sets configured by a network administrator and is involved in making core routing decisions.

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69
Q

Built-In Inflation Protection

A

A form of inflation protection that automatically increases all coverage amounts by a pre-specified amount (e.g., 5%) compounded annually. With this approach, the individual does not pay an additional premium cost each time the coverage amounts are increased, since the cost of the inflation protection is already included in the initial premium amount that individual is paying. Coverage increases continue even while the individual is receiving benefits. The amount of the annual increase depends on the amount chosen by the covered individual. Amounts of 3% to 5% compounded annually are typical.

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70
Q

Burn Rate

A

The rate at which benefits are being exhausted.

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71
Q

B&M Business Activity Monitoring

A

A method of tracking business activity in a database which can be viewed to understand application and process user activities or usage. At LTCG this is done in a number of areas including electronic application processing (eAPP) and eLTCAS.

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72
Q

Business Process Management or BPM

A

Technology used to automate business processes and decisions using workflow and other automation technologies with the goal of improving performance by minimizing errors, inefficiencies, and miscommunication

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73
Q

Business Process Outsourcing

A

A subset of outsourcing that involves the contracting of the operations and responsibilities of a specific business process to a third-party service provider

74
Q

Buyup

A

The portion of coverage an employee chooses to buy-up and pay for in addition to the core that is offered and paid for by the group.

75
Q

CWP CalPERS Web Portal

A

Also known as LTC Portal or LTC Program Portal.

76
Q

CAPEX Capital Expenditure

A

Funds that are used by a company for the purchase, improvement, or maintenance of long-term assets to improve the efficiency or capacity of the company.

77
Q

Care Advisor

A

The person, typically an LTCG Care Manager or Care Coordinator, who provides care management and care coordination services (e.g., assisting to locate eligible providers of care) to the claimant. When performed by an LTCG Claims Department Care Manager or Care Coordinator, the services of a Care Advisor from include determination of the claimant’s eligibility for coverage and long term care services required to meet their verified needs. With few exceptions, Care Advisory Services are provided at no cost to the claimant.

78
Q

Care Coordination

A

When performed by LTCG Care Managers and Care Coordinators, this includes, but is not limited to assisting claimants to locate eligible providers of care. When performed by Assessment Services staff as part of their efforts on behalf of people covered under Partnership policies, Care Coordination including identifying a person’s functional, cognitive, personal, and social needs for care and services and can help link the person to a full range of appropriate services. It may include but is not limited to the following:
• Performance of comprehensive individualized Assessments, including reassessments as needed;
• Development of Plans of Care, including an initial Plan of Care and subsequent Plans of Care as needed for changes in the Insured’s condition, by a Care Coordinator; and
Coordination of appropriate services and ongoing monitoring of the delivery of such services, when desired by the Insured or Representative and determined necessary by the Care Coordinator.

79
Q

Care Logs

A

Typically refer to the record of services provided to residents in non-nursing home facilities such as ALFs. Most ALFs do not maintain care logs.

80
Q

CMA or Care Management Agency

A

Entities which meet specific requirements of individual states’ Long Term Care Partnership Programs. Their responsibilities include, based on state requirements, performance of in-person assessments of care needs, construction of care plans and, in some cases, Certifications of Chronic Illness. LTCG’s assessment business, Life Plans and NCL, is an approved CMA and CMPA for several Long Term Care Partnership Programs.

81
Q

CM - Care Manager

A

An individual, within Care Management, that completes the claimant eligibility decision and issues a Plan of Care. Care managers are Licensed Health Care Practitioners. Care Coordinators perform many of the same functions, but are not LHCPs

82
Q

CP or Care Plan or ‘Plan of Care’

A

Care Plan or Plan of Care A Plan of Care typically developed by Claims Department Care Management staff documenting a claimant’s long-term care needs, services recommended to meet those needs, frequency and duration of services needed, as well as both formal and informal service providers. Plans of Care may also be done as part of the BEA by Assessment Services for those carriers who request this service. Included in the Plan of Care developed by LTCG Claims Department staff is the maximum covered expense for approved care and the maximum number of hours per day the policy will provide benefits for approved care.

83
Q

CareExchange

A

An LTCG claim technology platform that helps insurance carriers better manage and electronify homecare visits. CareExchange consists of an electronic visit verification (EVV) module for independent homecare providers, and an electronic claims clearinghouse for homecare agencies.

84
Q

Cash Surrender Value

A

The amount of money the life insurance company owes a policyholder when he or she terminates a life insurance policy or annuity contract with this feature. The policy states the amount of the cash value.

85
Q

CellTrak

A

Vendor used by Assessment Services for the tool the LTCG network of nurses use for the digital completion of in-person underwriting or claims assessments via tablet or laptop.

86
Q

CTI Certificate of Terminal Illness

A

An attestation from the physician or provider indicating an individual has a life expectancy of six months or less due to terminal illness.

87
Q

CNA

A

Certified Nurse Assistant A person who assists patients with personal care needs and cares for a patient who is ill or recovering from a surgery or disease. Other than monitoring basis vital signs, CNAs do not provide direct nursing services. Individual must meet training requirements and is certified by individual states.

88
Q

CAB Change Advisory Board

A

Group that conducts weekly meetings for Requests for Change (RFCs).

89
Q

CI or Chron Ill Chronically Ill / Chronic Illness

A

The benefit trigger under federally tax-qualified long term care policies, under which a person is deemed to be Chronically Ill if he/she is unable to complete at least two activities of daily living without substantial assistance (typically standby or hands-on) from another person for at least 90 days or requires substantial (continual) supervision as a result of severe cognitive impairment.

90
Q

CCNA Claimant Care Needs Assessment

A

A form completed by the claimant’s ALF that documents the person’s current functional and cognitive status, need for and receipt of medication administration assistance, and information about the level of supervision in place.

91
Q

CLMT Claimant/Member

A

The person or entity claiming benefits under a policy.

92
Q

CCM Claims and Care Management

A

Refers to LTCG Care Management and Claim Examination staff and processes.

93
Q

CCL Claims Call Log

A

A part of LTCG’s administrative systems (LTCAS, e/C/LTCAS) in which phone calls to and by LTCG staff are logged.

94
Q

CCOP Claims Case Overview Page

A

Page/tab in eLTCAS displaying information about the most recent claim, including a benefits overview, requirements gathered from a range of sources and the dates of the current approval period.

95
Q

Claims Clearinghouse

A

An intermediary in a claims process that connects providers to payers. Clearinghouses help validate claim information and map data from the provider’s source system to the payer’s system for electronic transmission.

96
Q

Claims Exam/Claims Examiner

A

The LTCG Department that ensures the appropriate benefits are issued based on policy benefits and the approved Plan of Care (POC).

97
Q

Claims Web Application

A

Claims Web Application is a browser-enabled solution for handling a growing set of claims-related processes. This solution includes maintenance of policy electronic plans of care (ePOC), claims entry, claim payee maintenance, and claim auto-adjudication.

98
Q

CA Client Accounting

A

The process of performing banking and financial reporting.
Functions in this area include: Setup of banking arrangements; Tracking bank account transactions; Processing claims, commissions and refund checks; Developing TPA fee invoices based on contractually agreed upon rates; Providing management reports to show revenue, cash receipts, refunds and other agreed upon reports (i.e. standard reporting package); Providing accounting and financial reporting expertise.

99
Q

CWP Client Web Portal

A

Website application where a client’s members can access benefits, claims, billing and demographic information about their coverage in real time and communicate with LTCG coverage administrators through a message center or by chat. The website also displays client specific long term care information and forms that can be helpful to the client’s members.

100
Q

CMS

A

Centers for Medicare and Medicaid Services, which is the federal agency within the Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid.

101
Q

COG Cognitive Impairment

A

A condition that impacts reasoning, intellectual capacity, or memory and results in confusion, disorientation, impaired judgment, or memory loss. Cognitive Impairment may be the result of dementia, such as an Alzheimer’s type, stroke, head injury or delirium following acute illness. Cognitive Impairment is a specifically defined term in long term care insurance policies.

102
Q

Cog Ques Cognitive Questionnaire

A

A form completed by a claimant’s physician upon request of LTCG, which documents the individual’s degree of cognitive impairment.

103
Q

Commissionable Event

A

A commissionable event is when policy’s receivable has been paid in full and commissions are paid to an agent or multiple agents.

104
Q

COSO Committee of Sponsoring Organizations

A

A joint initiative of five private sector finance-type organizations (including AICPA). Dedicated to providing thought leadership through the development of frameworks and guidance on enterprise risk management, internal control and fraud deterrence.

105
Q

Community-Based Care

A

Long term care services provided outside of facility settings. Examples include home care and Adult Day Care. Some policies include Assisted Living Facility care as community-based.

106
Q

COMP INF or CIP Compound Inflation

A

Compound Inflation is calculated on the purchased Maximum Daily Benefit (MDB) and Lifemax (LTM) for current coverage, and that MDB or LTM is multiplied by the number of years that need to inflate using the formulas below.
MDB = round (mdb * ( 1.0 + inflation percent ), inflation_round_length)
LTM = round (lifemax * ( 1.0 + inflation percent), inflation_round_length)
* Formulas represent one year of inflation, and needs to be run for each year with the MDB & LTM.
Every year the inflated MDB & LTM amount is stored to 8 decimals and all 8 decimals are used to calculate the next year’s inflation amount. (inflation_round_length)

107
Q

CI Configuration Item

A

Any component or other service asset that needs to be managed in order to deliver an IT service. Information about each configuration item is recorded in a configuration record within the configuration management system and is maintained throughout its lifecycle by service asset and configuration management. Configuration items are under the control of change management. They typically include IT services, hardware, software, buildings, people and formal documentation such as process documentation and service level agreements.

108
Q

Contestability Period

A

A period of time, defined in the policy, beginning on the effective date of a policy, during which the policy is subject to rescission if the carrier determines that material misinformation or omission of information occurred during the initial application process.

109
Q

CNA / CNAI / CNAG

A

Continental Assurance Co of North America / Individual / Group Client. LTCG currently only processes CNA’s individual business.

110
Q

CBUL Contingent Benefit Upon Lapse

A

A requirement in some states companies must offer if premiums increase to a certain amount (based on a table of increases). This enables policyholders to keep their policy without paying the higher premium. If offered, the policyholder could choose: 1) their current policy with reduced benefits so the premium stays the same; 2) a paid-up policy with a shorter benefit period, but no future premiums; or 3) their current policy with the higher premiums.

111
Q

Contingent Nonforfeiture or CNF

A

Long term care insurance coverage provision, automatically included in most if not all newer policies, which provides a limited amount of continuing coverage even if the coverage lapses due to non-payment of premium. The coverage defines what is considered a significant increase in premiums based on your age at the time you bought the coverage.

112
Q

CCRC Continuing Care Retirement Community

A

These facilities offer different levels of services, from independent living to skilled nursing, as an individual’s care needs change, sometimes allowing the person to remain in his/her original apartment as their care needs increase and other times requiring that they move within the community to areas better suited to address increasing needs.

113
Q

Continuous Payment Option

A

A premium payment option that requires the insured to pay premiums until he or she is eligible for benefits. Payment premiums can be monthly, quarterly, semi-annual or annual.

114
Q

CRI Contract Required Information

A

Internal LTCG form when requesting contracted vendor services.

115
Q

COB Coordination of Benefits

A

The process of determining which of two or more insurance policies will have the primary responsibility of processing/paying a claim and the extent to which the other policies will contribute.

116
Q

Core

A

The part of the coverage that is offered by a group and will be paid by the group; it is a completely defined set of product packages including the benefit levels.

117
Q

CBU Core Buy Up

A

Some employers offer long-term care coverage to their employees (and spouses) and pay for a level of coverage i.e. $50 Nursing Home Care – referred to as “Core”. The employees can then purchase additional coverage which is referred to “Buy Up”.

118
Q

CAP Corrective Action Plan

A

A CAP is a response to a known risk, vulnerability, or audit finding that describes the actions and schedule the organization will take to remediate the risk, vulnerability, or audit finding.

119
Q

Cost of Care Study

A

Comprehensive study document based on LTCG’s annual survey of over 30,000 senior care providers including homecare, assisted living facilities, skilled nursing facilities and adult day care centers. The study includes analysis of average and median costs by region, state and at the national level.

120
Q

COLI Cost of Living Increase

A

Carriers offer different inflation product features. Due to the increase in the cost of care, some products include a COLI product feature where the policyholder’s benefit amount increases according to certain criteria. (i.e. annual, % of inflation).

121
Q

CA Coverage Administration

A

The module within C/LTCAS which allows the processor to administer various tasks on a policy such as terminate, add or remove waiver of premium, issue a coverage change or reinstatement, etc.

122
Q

Coverage Change of Mind

A

Utilizing the coverage change of mind functionality allows a coverage change to be done on the policy (after being issued) where the updated coverage will maintain the original coverage effective date as if it was the only coverage ever held, and not require underwriting. The business typically only uses this functionality for changes in the freelook period; however, the system will allow a Coverage Change of Mind to process outside of the freelook period for exceptional cases (user must have rule with special authority).

123
Q

CED Coverage Effective Date

A

The date insurance coverage begins.

124
Q

CU/RV CU/RV

A

Coverage Units and Rate Vector development effort in LTCAS to provide flexible capabilities surrounding coverage and rate combinations. Provides more easily accessible data. (*only use when discussing rate vectors & coverage units in the SRS).

125
Q

Custodial Care

A

Non-skilled, non-nursing care intended to support activities of daily living, supervision for safety and other supportive services. Most long term care claims are for the costs associated with the provision of custodial care.

126
Q

DB Daily Benefit

A

A specified dollar amount that is the maximum amount to be paid per day for covered services.

127
Q

DVN Daily Visit Notes

A

A record of the daily services provided to a claimant by a provider of home care services.

128
Q

DRC Data Recognition Corporation

A

A vendor that LTCG’s clients use to print documents.

129
Q

DOL Date of Loss

A

The first date when the claimant incurred an expenses or received a service for which a claim is made.

130
Q

DED Deductible Period

A

A specified amount of time during which a claimant is considered eligible for benefits but which must pass before benefits are paid. Under some policies, eligible services must be received each day during this period. Under others, only one day of eligible service is required to initiate the period. Some policies count this period based on actual dates on which services are provided. Others count it on a calendar day basis whether or not eligible services are received.

131
Q

Dep Dependent

A

For the purpose of determining care needs, the determination that a claimant is unable to perform a listed activity. Under most policies, the level of assistance required must be by another person, however under some policies, a person may be dependent if they are reliant upon an assistive device, such as a walker or wheelchair.

132
Q

Designee Reminder Letter

A

The Designee Reminder Letter is correspondence that is used to prompt a policyholder to define and/or confirm the name and contact information for the person who should receive a copy of the Final Billing Notice letter in the event that the insured’s policy lapses.

133
Q

DB Direct Bill

A

The process of invoicing a policyholder directly when premiums are due.

134
Q

DI or DID Disability Insurance

A

A type of insurance that will provide benefits in the event an actively employed person is unable work due to a covered illness or injury.

135
Q

DLR Disabled Life Reserve

A

Reserves held for insureds who are currently on claim.

136
Q

DRE Disaster Recovery Exercise

A

A DRE is a set of policies and procedures which focus on protecting an organization from any significant effects in case of a negative event which may include cyber-attacks, natural disasters, building or device failures.

137
Q

DRP Disaster Recovery Plan

A

The DRP applies to major, usually physical disruptions to service that deny access to the primary infrastructure for an extended period. A DRP is an information system-focused plan designed to restore operability of the target system, application, or computer facility infrastructure at an alternate site after an emergency. The DRP may be supported by multiple information system contingency plans to address recovery of impacted individual systems once the alternate facility has been established. A DRP may support a BCP plan by recovering supporting systems for mission/business processes or mission essential functions at an alternate location.

138
Q

DOD DOD

A

Date of death.

139
Q

DOI

A

Department of Insurance.

140
Q

DOS

A

Date of service.

141
Q

DWOP Dual Waiver of Premium

A

Can be applied only when a policy covers both husband and wife. This rider provides for a waiver of premium for both of the insured in the event that either spouse needs to receive benefits.

142
Q

DME Durable Medical Equipment

A

Medical equipment (DME) typically used to aid in the performance of ADLs that are available on a rental or purchased basis, can withstand repeated use and are not designed primarily for any other use. Many pieces of DME are covered by Medicare and include wheelchairs, walkers, bedside commodes and hospital-style beds. Most long term care policies do not cover DME.

143
Q

DPOA Durable Power of Attorney

A

Authorization a person gives to another person(s) to represent them in the event of incapacity. A person with Power of Attorney is called the attorney-in-fact. Powers granted under a DPOA document are delineated in the document itself.

144
Q

Duration Band

A

A range of benefit duration levels that share the same age-based rate.

145
Q

Duration of Coverage Banding

A

In Resol, the duration of coverage banding refers to including or excluding policyholders within the same rate increase offer depending on how long their coverage has been in-force based on the number of years. For example, policies that have been in force for a minimum of 3 years will increase rates by x%, and policies that have been in force for a minimum of 10 years increase rates by y%.

146
Q

ePOC Electronic Plan of Care

A

An electronic record prepared by a Care Manager or Care Coordinator in the Claims Department that specifies the type, level and frequency of care required by a person determined to be eligible for benefits. The Electronic Plan of Care resides in eLTCAS. See eLTCAS.

147
Q

Escrow Agreement

A

A special client agreement to send date off-site to a third-party facility at specific intervals, such as annually, or after major code releases.

148
Q

Expense-Incurred Policies

A

For Expense-Incurred Policies, the insurer pays benefits once there an expense for eligible services. The policy pays either the amount of the expense or the policy’s dollar limit whichever is less. Most policies sold today are expense-incurred policies.

149
Q

Extended Term Benefits

A

After a policyholder stops paying premiums, this coverage provides full benefits for use during a certain period of time. If the policyholder doesn’t collect benefits during this period, the contract ends and the policyholder has no more coverage.

150
Q

ET Extra Territorial State

A

For group products, the location of the employer’s headquarters, or situs, dictates which insurance regulations apply – not the resident state of each insured. For example, if the employer is sitused in New York, New York State insurance regulations will apply to those employees who live in New Jersey, as well as those that live in New York. In the case of an extraterritorial state, that state’s insurance laws are applied to its residents, regardless of where the employer is sitused. For example, if a policy is issued or sitused with a New York State employer, individuals who reside in Connecticut – because Connecticut is an extraterritorial state – will be issued a certificate of insurance that complies with Connecticut insurance law.

151
Q

F2F or FTF Face-to-Face Assessment

A

An in-person evaluation of an individual’s functional and cognitive status employed as part of the initial underwriting process or claim process. See BEA. It is conducted by a licensed nurse contracted by LTCG. The interview usually takes place in the applicant’s home (which may include an ALF) and lasts from 45 minutes to 1 ½ hours on average.

152
Q

FCQ Facility Cognitive Questionnaire

A

A form provided by LTCG and completed by facility nursing staff when a facility’s records are deemed inadequate or not sufficiently current to enable an accurate decision as to a claimant’s eligibility for benefits. Information includes claimant’s current functional and cognitive deficits and the level of care and supervision provided by the facility staff.

153
Q

Final Billing Designee

A

A final billing designee is a person(s) elected by the insured to receive notice when a premium has not been paid on time. Both the insured and the Final Billing Designee will be notified 30 days after the premium due date for which premium was not paid and allows another 35 days for the premium to be paid.

154
Q

FBN Final Billing Notice

A

A final billing notice is a notice generated 30 days after the premium due date for which premium was not paid and allows another 35 days for the premium to be paid or risk lapse in coverage.

155
Q

FPOA Financial Power of Attorney

A

Instrument granting specified financial, not health care, authority to a person or persons. The person granted this power is the attorney-in-fact.

156
Q

FCR First Call Resolution

A

An operations goal to provide the required information to the caller on the first call so that a call-back is not needed.

157
Q

First Year Rate

A

The first year of a policy and is usually paid a higher commission rate.

158
Q

FIPO Flexible Increasing Premium Option

A

An optional premium payment method for a policyholder often elected at the time of issue. With FIPO, the policyholder is allowed to start their premiums at a lower rate and increase over the years until a cap age is met, then premium levels out until reaching a defined Rated Age; however, the policy must be in force for a minimum number of defined years before the cap is reached and premium begins to level. Upon paying level premiums until a defined End Age, the policy becomes paid up (no further premiums due). The policyholder must simultaneously have compound inflation protection (this does not include step-rated compound inflation protection or the guaranteed purchase option).

159
Q

FuncCog Functional/Cognitive Assessment

A

In LifePlan’s legacy system, an assessment used for claims abbreviated for the purposes of claims recertification.

160
Q

GNP Green Notepad

A

IT functionality in the CAS systems that allows users to communicate and archive changes and inquires on a specific policy.

161
Q

GB Group Billing

A

The process of invoicing a group representative, such as an employer, when premiums are due. Usually, a group bill account has more than one policyholder and has its own unique collection process.

162
Q

Group Model

A

Business defined structure on what is required to be associated to the insurance group to facilitate administration, reporting, or commission payments on the product.

163
Q

GI Guaranteed Issue

A

A term used to describe a situation where a policy is offered to any eligible applicant without regard to health status.

164
Q

Guaranteed Renewable

A

Coverage cannot be canceled or refused as long as premiums are paid on time and benefits have not been exhausted. This feature guarantees that your long term care coverage cannot be cancelled unless benefits have been exhausted or premiums have not been paid as due. The company cannot change the coverage or refuse to renew your coverage for any reason (including changes in your health, marital or employment situation), other than for nonpayment of premiums or if you receive the maximum amount of benefits available under your coverage. In a guaranteed renewable coverage, premium rates can increase, but only on an entire class of coverages; no one individual can be singled out for a premium increase.

165
Q

HCPOA Health Care Power of Attorney

A

Instrument granting specified authority, including decisions related to the provision of health care services, to a person or persons. The person granted this power is the attorney-in-fact.

166
Q

HHA Home Health Aide

A

A trained and often certified health-care worker who provides assistance to a person, typically in the person’s home, with personal care (ADL assistance, supervision for safety, medication reminders), as well light housekeeping and meal preparation.

167
Q

HHCA Home Health Care Agency

A

An agency or organization which meets state licensing requirements and/or policy requirements as a provider of Home Health Care or Home Care services. Policy and state requirements may vary significantly and may include licensure, staffing and specific service types.

168
Q

Homemaker Services

A

Services such as housekeeping, laundry, meal preparation, transportation and sometime shopping for essentials. Homemaker services do not include personal care services, e.g., assistance with ADLs, supervision for safety or assistance with medication.

169
Q

HCNA Hospice Care Nursing Assessment

A

The assessment of the care needs of a terminally ill person conducted by a provider of hospice care. Hospice providers focus on palliative, or comfort, care and their services are typically covered by both Medicare and long term care insurance. LTCG’s approach to the claims process for terminally ill claimants relies upon the Hospice Care Nursing Assessment provided by the hospice provider to determine if the claimant satisfies the long term care policy requirements for coverage rather than asking the terminally ill claimant to participate in an in-person assessment.

170
Q

Hybrid Policy

A

A life policy or annuity that includes an LTC rider.

171
Q

ICD9 ICD9

A

The industry standard for medical diagnosis and procedure codes associated with every procedure or service that has been performed. The ICD9 has been updated to the ICD10.

172
Q

ICN

A

independent contracted nurse.

173
Q

In Non-Forfeiture For purposes of Nonforfeiture or Contingent Benefits upon Lapse, the status a policy is in once the NF benefit has been activated. Characterized by new certificates with active coverage reflecting the new benefit values and premium amounts of $0.00.

A
174
Q

Indemnity Benefit Policies

A

For Indemnity Policies, the benefit is a set dollar amount that isn’t based on the specific service received or the expense incurred. Once the insurer / LTCG decide the insured is eligible for benefits because the insured is receiving long-term care services, it pays the set amount up to the limit of the policy.

175
Q

IP Independent Provider

A

Independent Care Providers (IP) are caregivers who are hired directly by the claimant or their legal representative. The caregiver is not hired as an employee of an agency. Some plans include IPs as covered providers of home care services, others include them only if certain criteria are met. LTCG considers Independent Care Providers to be Household Employees, consistent with IRS Publication 926.

176
Q

Inflation Protection

A

Inflation protection is a coverage provision or rider that increases annually the daily benefit maximum and total coverage amount in order to keep in pace with inflation. The increase may be simple or compound and may occur automatically each year, periodically or upon request.

177
Q

I&R Information & Referral

A

Information and Referral (I&R) is the process where the claimant/legal representative is provided with information about eligible provider(s) of long term care services in their geographic area and qualified to provide the long-term care services sought by the policyholder. It may be offered to a policyholder even if the individual is not approved for benefit. I&R services are usually provided when an approved claimant desires assistance to locate eligible care. These services are provided in writing and the policyholder is under no obligation to select a provider from the list.

178
Q

IADL Instrumental Activity of Daily Living

A

Activities a person must be able to do in order to function independently in their home, including grocery shopping, meal preparation, laundry, housework or handyman work, using the telephone, getting to places beyond walking distances, managing medications, and money management.

179
Q

Insurance Group

A

The second highest organizational level of the LTC Administration System, following Carrier, that is stored in the System Set-up module. Specific setup functions must be associated to the Insurance Group prior to allowing systematic administration, reporting, or commission payments on the product.

180
Q

Insurance Plan

A

Grouping of product packages from a common plan type. An insurance plan can belong to several insurance groups.

181
Q

Intake Call

A

The call between LTCG and the claimant or legal rep in response to a request to open a new LTC claim.

LTC Terms (1 decks)

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