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Conditions to the Payment of Benefits
All policies will require you to meet certain "conditions"
after the "benefit triggers" have been met and before benefits will
be paid.
Elimination Periods: The Elimination
Period (sometimes called a "Waiting Period" or "Deductible Period")
is the period of time you must wait after you qualify for care, and
are eligible to receive benefits before the company will begin paying
for your care. You choose the length of the Elimination Period when
you buy the policy. The most common options are 0 days, 30 days, 60
days, 90 days or 100 days. Some policies only make you meet the Elimination
Period once during the life of the policy, others apply it again after
you have gone for a certain period of time without needing care. In
most situations the elimination period will be satisfied by a day of
either in home care or institutional care. The premiums are usually
more for short elimination periods and less for a longer one. Be sure
to ask your qualified agent to explain these differences.
The elimination or deductible period is the length
of time that the insurer pays no benefits. If you select a 0-day Elimination
Period, the policy will begin paying on the first day you qualify for
care. If you choose one of the other periods you will be responsible
for paying the full cost of your care for these days.
Example: If you choose an Elimination
Period of 60 days, you will be responsible for the cost of the first
60 days of your care. If you are in a nursing home that charges you
$100 per day, you will pay approximately $6,000, before the policy starts
paying. If you leave the nursing home before the 60 days expires and
the policy only pays for institutional care, it would pay nothing for
that period of care.
If you qualify for benefits in a home care setting
most long-term care insurance policies apply a day towards your Elimination
Period for any day you actually receive care (or a home care visit).
Therefore, if your plan of care only calls for 3 visits per week you
will only satisfy 3 days towards your Elimination Period. Some companies
offer a more liberal interpretation of this definition. For example,
the policy might say that if you have one home care visit per calendar
week that you have satisfied 7 days towards your Elimination Period.
In this example, you would satisfy your Elimination Period more quickly.
Several companies now utilize a "calendar day" definition
for the elimination period. Once the insured has been certified as being
chronically ill each calendar day counts towards the elimination period,
regardless of whether formal long-term care services are received. This
allows the insured person to get informal care from family or friends
during the elimination period. After the elimination period has been
satisfied formal paid care can begin.
The premium cost is usually higher if you choose the
shorter Elimination Periods and is lower if you choose a longer period.
In addition a premium might be higher when the company uses a more liberal
"counting" of home care Elimination Period days. Also, make sure that
the Elimination Period days that are accumulated either in a home care
or institutional care setting are combined to satisfy your overall elimination
period. Be sure to ask your qualified agent to explain this.
Long Term Insurance
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