Insurance - Long-Term Care - Features - Coverage, Benefits, and Related Issues
After a decision to purchase long-term case insurance has been made, a savvy consumer will closely compare policies to determine which, also taking cost into consideration, best fits his or her needs. Policies have many different features relating to the definition of long-term care; the amount and type of benefits and benefit periods; and exclusions. Additionally, some policies provide for death benefits.
Definitions of Long-Term Care
First and foremost, it is important to realize that insurance companies may define long-term care differently. Individual policies will define the term, particularly the type of care provided and the location at which the care may be provided. Some policies limit the type of care they will cover. For instance, skilled nursing care, the traditional nursing home care, is always covered by long-term care policies. However, insurance companies may vary how they determine whether a nursing home placement is proper and therefore covered. A few will defer to a patient's doctor, but most will conduct an independent determination of whether the placement was medically necessary using insurance company guidelines.
Whether immediate care and personal care are covered also depends upon the policy at issue. Personal care typically involves assistance with daily tasks, such as grooming and eating. Personal care is sometimes provided in a person's home, but it may also be provided at adult day care centers and senior centers, for example. Intermediate care involves a level of nursing care somewhere between skilled nursing and personal care. In addition to defining the level of care necessary for coverage, policies often also dictate where coverage must be provided.
Amount of Benefits and Benefit Periods
Second, the amount of benefits and the time for which benefits will be provided varies from policy to policy. Long-term care benefits are usually stated as a dollar amount per day, such as $ 75 or $ 100 per day. Additionally, policies vary in the length of time they provide benefits. Some cover long-term care for only one year, while others cover long-term care as long as it is provided. In most instances, benefits for home care are covered for a shorter period of time than is skilled nursing care.
Exclusions
Third, all long-term care policies contain exclusions, which are things that are not covered. All or nearly all policies, for example, will not cover long-term care that results from mental conditions or nervous disease, at least not without accompanying demonstrable organic disease. One exception to this exclusion that is sometimes offered is Alzheimer's disease. Policies also do not cover long-term care that occurs as a result of drug or alcohol addiction or self-inflicted injuries. Yet another common exclusion is for long-term care that results from war illnesses or injuries. Finally, long-term care that is paid for by the government is always excluded from these policies.
Death Benefits
Finally, some policies provide for a death benefit, in which case some of the premiums paid by an insured is refunded to his or her estate at death, provided premiums were paid for a specified amount of time.
Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.
