|
Individual vs. Group Insurance
An individual long-term care insurance policy is a contract between
you and the insurer. These policies must be approved by the California
Department of Insurance (CDI) and have all of the consumer protections
required under California law. Individual policies are "guaranteed renewable"
and cannot be canceled by the insurance company unless the premium is
not paid on time. However, every company has the right to increase the
premiums it charges with proper notification and approval from the Department
of Insurance.
Group long-term care insurance is a contract between
an insurer and a group, such as an employer on behalf of its employees,
or a trade or professional association on behalf of its members. If
you are covered under a group plan, you receive a "certificate" rather
than a "policy" of insurance. Also, many of the policy terms have already
been negotiated by the group, and the group (called the "master policyholder")
has the option to terminate the policy at any time. Often, but not always,
group insurance is less expensive than individual health insurance. If group
coverage is terminated, you have the right to continue the coverage
or buy a conversion policy, depending on the provisions of the policy
and other factors. If you purchase group coverage, ask about what options
will be available to you if the group cancels the policy or if you lose
your membership or eligibility. Be sure to ask if the premiums will
change, and ask how you will be notified.
Note: If you are considering buying
group insurance, investigate the sponsoring group. Be sure the group
is negotiating in your interest. Some group policies do not have to
be approved by the California Department of Insurance, although the
company is required to send information about the policy to the Department
for its records. The master policy can be cancelled by the carrier or
the sponsoring group, at its option.
What Services Do Insurance Policies Cover?
Insurance policies describe where they will pay for care, what kind
of care they will pay for, who can provide the care, and conditions
that have to be met before a company will pay benefits. Described below
are the services required in a long-term care insurance policy approved
under current state law. You should be aware however, that California
law has changed many times over the years, and that insurance policies
sold in previous years may have different requirements than are shown
here.
Facility Coverage: In California,
most skilled, intermediate and custodial care is received in nursing
homes that are licensed as "skilled nursing facilities". All long-term
care policies except Home Care Only cover this kind of care.
Policies sold after October, 2001 (except Home Care
Only policies) are required to include a benefit to cover care in an
assisted living facility licensed as a Residential Care Facility for
the Elderly (RCFE). Some insurance policies sold before October, 2001
also include this benefit. RCFE's are not nursing homes, but living
arrangements where a person can also receive personal care or supervision.
Some RCFE's are large retirement homes, while others are small group
homes.
Home Care Coverage: Every long-term
care insurance policy called "Home Care Only" or "Comprehensive Long-Term
Care" issued after January 1, 1993 must include at least the following
6 Home Care benefits and other consumer protections which should make
it easier to receive care at home.
1. Home Health Care is skilled nursing
care or other professional services in your residence.
2. Adult Day Care is medical or social
care in a daytime program in a licensed facility which provides personal
care, supervision, protection, or assistance in the following: eating,
bathing, dressing, moving about and taking medications.
3. Personal Care is assistance with
any of the Activities of Daily Living or ADL's including Instrumental
Activities of Daily Living (IADL's) such as using the telephone, managing
medications, moving about outside, shopping for essentials, preparing
meals, doing laundry and light housekeeping.
Under California law, these services may be provided
by a skilled or unskilled person as long as they are required in a Plan
of Care developed by your doctor or a team of health care workers under
medical direction.
4. Homemaker Services assist you with
tasks or activities such as cooking, cleaning and other activities to
help you remain in your home.
5. Hospice Services are services in
your residence designed to provide physical, emotional, social and spiritual
support for you, your caregiver and your family when a terminal illness
has been diagnosed. Some policies will pay for these services in an
institutional setting as well.
Under California law, these services (like Personal
Care) may be provided by a skilled or unskilled person so long as they
are required in a Plan of Care developed by your doctor or a team of
health care workers under medical direction.
6. Respite Care is short-term care
provided in a nursing facility, in your home or in a community-based
program, which is designed to relieve the primary care giver in your
home.
Long Term Insurance
| Bluecross Long Term |
California Long Term Insurance
| Kaiser Long Term |
Long Term PPO plans|
Long Term Medical plans | Long
Term Dental Insurance |
Long Term Group
Insurance | Long Term Blueshield
| Long Term Health Insurance
|
Long Term Health
plans | Long Term Health net
| Long Term Pacificare | Long
Term Medical Quote |
Long Term Aetna
PPO plans | Long Term Insurance
Quote | Long Term HMO plans
|
Long Term Life
Insurance | Long Term Dental
plans
|
