Accelerated Death Benefit – A life insurance policy feature that lets you use some of the policy’s death benefit before you die.
Activities of Daily Living (ADLs) Everyday functions and activities individuals usually do without help. ADL functions include bathing, continence, dressing, eating, toileting and transferring. Many policies use the inability to do a certain number of ADLs (such as 2 of 6) to decide when to pay benefits.
Adult Day Care Care during the day for adults, usually at senior or community centers. It is a beneficial option for individuals receiving care at home whose family caregivers work and who need someone to be with them during the day.
Aging in Place Occurs when an aged individual continues to live and receive care at home, instead of being institutionalized.
Alternate Plan of Care In certain circumstances, benefits for services that are not specifically covered under a long term care insurance plan can be authorized.
Alzheimer's Disease A progressive, degenerative form of dementia that causes severe intellectual deterioration.
Assessment A determination of an individual's physical and mental health by a health care professional based on established medical guidelines. For qualified long-term care insurance policies, the assessment must be made by a licensed health care practitioner.
Asset-Based Long-Term Care Definition - Asset-based long-term care insurance is a life insurance policy. It allows you to leverage your death benefit to pay for nursing care costs. Normally, life insurance pays a death benefit to your beneficiaries when you pass away. This money can then be used to pay for funeral and burial expenses. Also, it can cover day-to-day living expenses for your loved ones, wipe out debts, or meet other financial needs.
Assisted Living Facility A residential living arrangement that provides individualized personal care and health services for people who require assistance with activities of daily living.
Bed Hold Benefit Will pay for the cost of reserving an insured's bed in a nursing home or assisted living facility while the individual temporarily leaves the facility up to a certain number of days.
Benefit Period The maximum period that an individual can receive benefits for a qualified long-term care event.
Benefit Triggers – The criteria and ways an insurer decides when a policy pays benefits, such as being unable to do two or more activities of daily living, or the need for substantial supervision due to having dementia or Alzheimer’s disease.
Care Coordinator A professional care manager, usually with a background in health care, provided by a long-term care insurance company. The Care Coordinator works with the insured and the insurance company to create a plan of care when a long-term care need arises.
Care Management Services – A service in which a professional, typically a nurse or social worker, may arrange, monitor or coordinate long-term care services (also called “care coordination services”).
Caregiver - Primary The main person (usually a relative) who is managing and providing care for a person who is incapacitated.
Caregiver - Secondary Others who help to provide care, usually on a part-time basis.
Certificate of Coverage – A certificate you receive or may request from the plan sponsor after buying coverage in a group policy. The certificate is evidence of your coverage under the policy and describes the benefits, coverage, exclusions and limitations of the policy that principally affect you.
Chronically Ill Individual A person who has been certified by a licensed health care practitioner within the preceding 12 month period as (1) being unable to perform without substantial assistance from another individual at least 2 out of 6 activities of daily living for a period of at least 90 days due to loss of functional capacity or (2) requiring substantial supervision to protect such individual from threats to health and safety due to cognitive impairment.
Claims Offset Language Contractual language within long term care policies that allow the insurance company to apply inflationary benefit increases only to the remaining pool of money amount within the policy. a policy without Claims Offset language will provide benefits for a longer claim period than a policy with Claims Offset language.
Cognitive Impairment - A deficiency in a person's short or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.
Community-based Services Includes services and programs such as meals on wheels and adult day care, that are designed to help people remain independent and/or in their own homes
Compound Inflation Protection - An option offered on some long-term care policies to automatically increase the maximum daily and lifetime benefits each year by a pre-set percentage on a compounded basis. It is available at an additional premium. Compound inflation protection is a very important benefit for individuals in their 40’s, 50’s, and 60’s.
Contingent Benefit Upon Lapse – A requirement in some states that companies are required to offer if premiums increase to a certain amount (based on a table of increases) to enable 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.
Contingent Non-Forfeiture - Standard regulatory benefit within all long term care insurance policies to protect policyholders in the event of a significant rate increase. Contingent upon the rate increase the policyholder may elect to cancel its policy and receive a paid-up long term care i
Continuing Care Retirement Community A residential retirement community where a variety of living and medical services are provided to residents who are in need of continuous care and/or supervision.
Continuous Payment Option – A premium payment option that requires the policyholder to pay premiums until s/he is eligible for benefits. The premiums can be paid monthly, quarterly, or once or twice a year. The policy is guaranteed renewable, which means the only reason the company can cancel it is if the premiums aren’t paid when due.
CPI-Based Inflation An option offered on very few long term care policies to increase the benefits on an annual basis based upon the Consumer Price Index. The CPI-U index has averaged 2.5% since 1983. The CPI-U index is likely to lag behind rising healthcare costs.
Custodial Care Care to help individuals meet personal needs such as bathing, dressing and eating. Someone without professional training may provide care.
Durable Medical Equipment Equipment such as hospital beds, crutches, wheelchairs, ramps and prosthetics used for in-home care.
Elimination Period A type of deductible; the length of time the individual must pay for covered services before the insurance company will begin making payments. Typically 30, 60 or 90 days. The longer the elimination period in a policy, the lower the premium. The elimination period may also be called the waiting period.
Facility Qualifications Specific standards required by state or federal regulations and by the long-term care insurance company (in states where no licensing or certification is required by the state) for a particular type of facility, such as a nursing home or adult day care center, to operate in a state and provide care or services that will be covered by a long-term care policy. Standards may include such things as licensing requirements, type of care services that must be provided, hours of operation, training and experience of caregivers. Facility qualification standards may vary by state and insurance policy.
Filial responsibility is defined as a duty owed by an adult child for his parents' necessities of life. Many states have laws that can require adult children to be financially responsible for their parents' necessities of life when the parents don't have the means to pay for them on their own.
Franchise Insurance determines minimum threshold of the insurance companies' financial responsibility. Insurance companies will not be paying any amount for the losses, which do not pass the mentioned franchise value on the insurance policy. If the losses exceed the franchise amount, then insurance company covers full damage. franchise exists when the insurance company is not responsible for the loss which does not exceed an agreed amount, but is responsible for the entire amount of the loss which exceeds the agreed amount.Often utilized with private lable and group coverage.
Free Look Provision A policy provision allowing the policy owner to inspect the policy for a specified period of time, often 10, 15, 20 days and to return the policy to the insurer, if desired, for a refund of the entire premium paid. Qualified long-term care policies are required by federal and state law to provide a free look period of 30 days. If the policy is returned within 30 days, the company must refund all of any premium(s) paid.