- Benefits
- Inflation Protection with the Automatic
- Instrumental Activities of Daily Living (IADL's)
- Insured
- Insurer
- Quote
Activities of Daily Living (ADL's)
The basic activities and functions performed on a daily basis that are usually done without assistance. The six ADL's are:
1. Eating
2. Dressing
3. Bathing
4. Toileting
5. Transferring
6. Continence
An individual employed by the insurance company to handle all matters, financial and otherwise, regarding the welfare of the claimant for cost effective purposes. This includes, but is not limited to, selecting physicians, specialists, care centers, hospitals, etc. as well as coordinating time periods of care
A person who assesses the needs of elderly people in terms of what services they need, often arranges for these services and keeps in touch with the person. The geriatrics manager is often hired by the person's immediate family to keep them informed of the person's status when they cannot be there themselves
HIPAA (The Health Insurance Portability and Accountability Act of 1996)
This act became a law on January 1, 1997. The act states the requirements that a long term care policy must follow in order that the premiums paid may be deducted as medical expenses and benefits not paid be considered as taxable income
Home Care Providers
A person who provides home health care or hospice services and who meets the following criteria:
1. Under the Medicare Program, has an agreement to be a provider of home health care services
2. Is licensed by their state as a home health care agency or hospice if licensing is required in the state in which they are practicing
3. Is a licensed therapist, a registered nurse (R.N), a licensed practical nurse( L.P.N), or a licensed vocational nurse (L.V.N.) providing services under the guidelines of their license
A person who provides home health care services or hospice care who:
1. Is licensed to provide the care they are giving and are working independently from a home health care agency. They must be licensed in the state they are working in.
2. Is chosen by You and has been qualified under the Independent Caregiver Certification Benefit
3. Is not a member of your immediate family living with you
A loss or breakdown of the mental capability that is similar to Alzheimer's Disease and similar forms of dementia. It is measured by clinical evidence and standard tests that provide valid information regarding the patient's impairment which includes (1) memory both short-term and long-term, (2) orientation to people, places, or time, and (3) deductive or abstract reasoning
Beginning January 1, 1997, long-term policies meeting certain requirements qualify for favorable tax treatment. Buyers of these plans may deduct the premiums if they itemize their deductions on their Federal Tax return. Premiums are treated as medical or health insurance expenses and must be equal to more then 7.5% of adjusted gross income. Also, benefits received from a Tax Qualified Plan (TQ Plan) are not taxable up to $175.00 a day
The basic activities and functions performed on a daily basis that are usually done without assistance. The six ADLs are:
Eating
Dressing
Bathing
Toileting
Transferring
Continence
Accumulation Period: The pre-determined amount of
time that must pass before the benefits are to go into effect for
the claimant.
Adult Day Care: A daily program made up of social and health-related services provided daily outside the home in a group setting to support weak, elderly, or other adults with impairment.
Age Limits: Stated minimum and maximum ages below and above that the insurance company will not accept policy applications.
Alzheimer's Disease: A degenerative disease of the brain which attacks nerve cells in the cortex of the brain thereby impairing a person's abilities to think and function.
Assisted Living Facility: A facility which provides 24 hour around the clock care to resident patients in need of assistance with any number of the Activities of Daily Living (ADLs).
Baby Boomer: A person born between the years of 1945 and 1964.
Benefits: Money paid by the insurance company to
the claimant.
Benefit Limits: An amount that represents the daily benefit times the maximum number of days you can receive for all benefits combined under the policy.
Benefit Options: Each carrier's insurance type generally has a set list of available benefits. Each benefit comes with a price.
Benefit Period: The amount of time an insurance company will make payments to the individual to pay for care, etc after the deductible has been satisfied.
Benefit Triggers: Specific situations that start
payment of benefits.
Board and Care Homes: Provides seniors with a room, meals, and assistance with ADL's and some supervision for their safety. These homes are generally not certified by Medicaid, but are licensed and approved by the State.
Cancellation: Done either by the insurer or insured, this discontinues the policy before its normal expiration date.
Caregiver: The individual who cares for someone with
a disability or illness. The primary caregiver is usually a spouse,
child or other relative.
Care Coordinator: An individual employed by the insurance
company to handle all matters, financial and otherwise, regarding
the welfare of the claimant for cost effective purposes. This includes,
but is not limited to, selecting physicians, specialists, care centers,
hospitals, etc. as well as coordinating time periods of care.
Care Manager: A trained professional who is able to work with you and your family and your doctors to assess your situation and determine the appropriate Plan of Care. They will also help with finding the available care resources.
Care Plan: This is a written plan formulated by a
health care professional after an assessment has been done on the
individual with a chronic illness or disability. The plan provides
a detailed outline of the person's needs and what health services
are required to meet those needs.
Case Coordinator: This is your contact person to
discuss claims and benefits.
Chronically Ill: A condition that is verified by a physician that renders the individual unable to perform at least two of the activities of daily living (ADL's) for at least 90 days, which requires the individual to have substantial supervision to protect themselves from threats to health and safety.
Claim: A submitted request to the insurance company by the claimant to receive payment and/or reimbursement for expenses incurred due to disability, illness, etc. which are covered under said policy.
Cognitive Impairment: Loss of rational comprehensive thought processes due to a degenerative disease or disorder.
Commission: A part of the premium that is paid to
the policyholder's agent or broker for their services in the insurance
policy process.
Congregate Housing Facilities: Similar to a dormitory setting, individuals have their own private rooms, but often share meals. Care is generally minor supervision to provide safety with emergency medical assistance always available.
Consideration: Acceptance by the insurance company of the payment of the premium and the statement made by the prospective policyholder in the application.
Contingent Beneficiary: The person who will receive
the benefits of a policy or plan if the main beneficiary dies while
the insured is living.
Contract: A binding agreement between two or more
parties stating specific terms and agreements. A contract of insurance
is a written document known as a policy.
Contract Holder: The person, group, or entity, which
the contact is issued.
Coverage: The amount of protection provided under
the contract of insurance.
Covered Nursing Care Facility (Confined) Benefits:
Policies that provided benefits for all levels of care will pay for
benefits in a nursing home that is licensed in the state in which
the claim is being made.
Custodial Care: Non-medical care in which the patient
receives help with their ADL's. Providers of this care do not need
to be professionally trained nurses or therapist.
Daily Benefit Period: The length of time which your
daily benefits cover.
Daily Benefit Rate: The rate predetermined by your
policy provider to cover your daily benefits.
Declination: The refusal of an insurer to issue a
policy based on the review of the application for insurance and other
relevant factors
Deductible An out-of-pocket amount of money that the insured must
pay before the insurance company assumes financial responsibility
for the claimant's expenses.
Deductible: An out-of-pocket amount of money that
the insured must pay before the insurance company assumes financial
responsibility for the claimant's expenses.
Deposit Premium: This is the initial premium paid by the prospective policyholder when the insurance application is filled out. This is generally equal to the first month's premium and is applied towards the first month's actual premium.
Effective Date: The date on which the insurance
policy begins.
Eldercare Locator: A national hotline service that
refers people to local services if you or someone you know needs long
term care. The number is 1-800-677-1116.
Elimination Days: A period of time between the initial
need for care and the beginning of the payments from the insurance
company.
Elimination Period: The number of days that you have
to pay benefits before your coverage begins to pay for benefits.
Evidence of Insurability: Statements or proof or
a person's physical condition affecting the acceptance for insurance.
Favorable Tax Treatment: Benefits are received free from tax. Also, your premium and long-term care expenses may be deductible from your Federal Income Taxes, within reason. Please contact your tax advisor for more information.
Free-Look Period: Once you buy a policy, most states allow you up 30 days to return your policy. Make sure to get written proof of this option when you receive your policy.
Gatekeeper: Decided when a patient should be referred
to a specialist or when particular tests should be given.
Geriatrics Manager: A person who assesses the needs
of elderly people in terms of what services they need, often arranges
for these services and keeps in touch with the person. The geriatrics
manager is often hired by the person's immediate family to keep them
informed of the person's status when they cannot be there themselves.
Gross Premium: The premium paid by the policyholder.
Guaranteed Rate Policy: Written agreement stating
premium rate will not increase over time.
High Risk Individuals: People who have a pre-existing
health condition that have a greater than average probability of future
medical expense.
HIPAA (The Health Insurance Portability and Accountability
Act of 1996):
This act became a law on January 1, 1997. The act states the requirements
that a long term care policy must follow in order that the premiums
paid may be deducted as medical expenses and benefits not paid be
considered as taxable income.
Home Care Providers: A person who provides home health
care or hospice services and who meets the following criteria:
1. Under the Medicare Program, has an agreement to be a provider
of home health care services
2. Is licensed by their state as a home health care agency or hospice
if licensing is required in the state in which they are practicing
3. Is a licensed therapist, a registered nurse (R.N), a licensed practical
nurse( L.P.N), or a licensed vocational nurse (L.V.N.) providing services
under the guidelines of their license
Home Care Services: Household services done by someone
else because you are unable to do them yourself. These include nursing
services, personal hygiene, house chores, errands, and preparation
of meals, laundry and small house maintenance.
Home Delivered Meals: "Meals on Wheels",
provide meals to those who cannot cook for themselves
Home Health Aid: Licensed individual that performs
daily care for those in need of assistance in their homes. Generally
these people provide help with basic daily activities such as bathing,
eating, and dressing.
Homemaker Service: Generally in combination with
a Home Health Aide, this person will cook, clean, run errands, etc.
Hospice Care Services: Out patient services provided
by a licensed hospice provider to help ease the pain of terminally
ill patients in their last stages of their terminal disease. They
also provide support to the primary care giver and the family.
House Claims Department: Department that processes
and reviews all claims.
Immediate Family: The person's spouse, children,
parents, siblings, grandchildren or in-laws.
Incurred Services: Received services from providers.
Indemnity: Compensation to the claimant for disability
or illness suffered - security against loss.
Independent Agent: A business person that represents
two or more insurance companies in sales and service and who is paid
on a commission basis.
Independent Caregiver: A person who provides home
health care services or hospice care who:
1. Is licensed to provide the care they are giving and are working
independently from a home health care agency. They must be licensed
in the state they are working in.
2. Is chosen by You and has been qualified under the Independent Caregiver
Certification Benefit
3. Is not a member of your immediate family living with you
Informal Caregiver: Usually a spouse or relative,
an informal caregiver is an unpaid individual who takes on the responsibility
of providing care for the individual in question.
Inflation Rate: The rate, which the cost of long-term
care is expected to increase in the future. Generally this rate is
1-2% higher than the overall U.S inflation rate.
Inflation Protection with the Automatic Increase Benefit Rider
AIB: A rider that helps you to keep up with the potential
cost of your care due to inflation. The rider increases your maximum
daily benefit either on a simple or compound basis, depending on the
rider you choose.
Instrumental Activities of Daily Living (IADLs):
Determines the physical and mental impairment while performing activities
such as shopping, telephone use, housekeeping, laundry, taking medications,
and managing finances.
Insurance: A system of exchange under contract where
payments over a period of time (premiums) entitle individuals compensation
by an organization (insurance company) in the event of loss due to
pre-specified conditions.
Insurance Carrier: Insurance provider.
Insurance Policy: A legal contract issued by the
insurance company to secure coverage for claimant.
Insurance Premium: The pre-specified amount an individual
pays to guarantee coverage for a policy.
Insured: A person covered under an insurance policy,
including any persons named as receiving protection under the policy.
Insurer: The insurance company that agrees to pay
losses of benefits. Also, the insurer can be any company whose primary
business is selling insurance to the public.
Insuring Agreement: The part of the insurance policy
that specifies the promises of the insurer.
Insuring Clause: A statement that specifies the type
of loss covered by the policy and the parties involved in the insurance
contract.
Intermediate Nursing Care: This care is provided
to those who do not need care on a 24-hour basis. A skilled care person
on a non-continuous basis provides the nursing care.
Lapse: The ending of the insurance policy due to
the non-payment of a premium.
Lapsed Policy: A policy, which has discontinued due
to the non-payment of premiums.
Level Premium: A premium that remains the same throughout
the life of the policy.
Licensed Health Care Provider: A doctor, or health
care professional, who certifies every 12 months that you are continuously
ill and in need of support.
Long Term Care: Care given in the form of medical
and support services to persons who have lost some or all of their
capacity to function due to an illness or disability. These services
are generally provided away from the primary health care facility
and are of a long time frame.
Long Term Care Insurance: The insurance which pays
for a succession of care giving services for the elderly or chronically
ill. This care may be provided in a facility (nursing home, mental
hospital, etc.) or in the individual's home with a nurse or aide.
Maintenance or Personal Care Services: Any care where
he main reason for which the care is provided is to assist those in
need of care resulting from a chronic illness or disability.
Married Couples Discount: A plan that offers a reduced
rate to those couples that apply for coverage and are approved.
Maximum Lifetime Benefit: The total amount Your carrier
will pay you in Your lifetime for all benefit provided under your
policy.
Medicaid: Public assistance funded through the state
to individuals unable to pay for health care. Medicaid can be accessed
only when all prior assets and funds are depleted.
Medical Help System: A communication system set up
in your home that is used to contact medical personnel in the case
of an emergency.
Medicare: A Government program, administered by the
Social Security Administration, which provides financial assistance
to individuals over the age of 65 for hospital and medical expenses.
Medicare does not cover long-term care expenses.
Medigap: Private health insurance that is used to
pay costs not covered by Medicare, such as deductibles and co-insurance.
Mode of Premium Payment: The schedule of payment
of premiums, monthly, quarterly, semiannually, or annually.
National Association of Insurance Commissioners (NAIC):
A national organization made up of state officials who are in charge
of regulating insurance. They have considerable influence and strive
to promote national uniformity in insurance regulations.
Named Insured: The first person in whose name the
insurance policy is issued.
Payment of Claim: Timely payment, generally monthly after services have been given to patient and the filed claim is proven valid.
Plan of Care: A program of care and/or treatment
that is set up with your licensed physician and approved in writing
before the start of care.
Policy: A written legal contract of insurance issued
by the insurance company to the policyholder, which outlines the terms
of the insurance.
Policy Holder: Individual that has a written and
signed agreement with their insurance provider.
Policy Language: Clarity of policy explanation.
Policy Lapse: Length of time the since policy has
been active.
Policy Term: The length of time the insurance policy
provides coverage.
Premium: The annual payment from the individual to
the insurance policy to keep the policy active.
Premium Rates: Rates that determine amount of the
premium. It is important to research the history of rate increases
for each perspective carrier.
Premium Stability: The amount of risk involved in
maintaining current premium rate. The lower the chance of the rate
fluctuating, the lower the risk and the higher the premium stability.
Proof of Loss: Documents , such as bills that show
the break down of money spent on services provided.
Quote: A proposed estimation of the needs of the
assessed individual to determine an appropriate policy.
Rate: The pricing factor that the insurance company
bases their insurance buyer's premium.
Rated Policy: Also known as an "Extra-Risk"
policy, this policy is issued at a higher than stated premium rate
due to extra risk in the policy holder, such as impaired health or
a dangerous occupation.
Ratemaking: The process by which insurance companies
determine the risks and the pricing for the classes of insurance.
Reimbursement: Payment back to the claimant for expenses
incurred out of pocket which are inherently covered by the policy.
Renewal: The continuance of the coverage of a policy
that is beyond the original length of time set in the original policy
based on the acceptance of the new policy's premium.
Respite Care: Care provided through a long-term care
facility to temporarily relieve the informal caregiver's burden of
responsibility.
Rider: Written contract agreement between insurer
and insured which changes the policy or certificate.
Risk: The chance of loss.
Senior Centers: Provide an assortment of social and
recreational services. Many provide programs offering low cost or
free meals.
Senior Citizen Policies: Insurance policies for those
over the age of 65. In many cases these policies are in combination
with coverage provided by the government under the Medicare Program.
Senior Transportation Services: Help seniors with
their shopping, medical appointments and other appointments.
Severe Cognitive Impairment: A loss or breakdown
of the mental capability that is similar to Alzheimer's Disease and
similar forms of dementia. It is measured by clinical evidence and
standard tests that provide valid information regarding the patient's
impairment which includes (1) memory both short-term and long-term,
(2) orientation to people, places, or time, and (3) deductive or abstract
reasoning.
Skilled Nursing Care: This is the highest level of
care provided by a Registered Nurse (R.N) or a Licensed Practical
Nurse (L.P.N) 24 hours a day. It is prescribed by a physician for
the most severely impaired person who cannot perform their own personal
needs.
Spousal Discount: Set discount if policy holder is
married.
Stability of Carrier: Strength of the insurance carrier
based on their profitability and market share.
Substantial Supervision: This is continuous supervision
that is proved to those who have Severe Cognitive Impairment, which
threatens their health and safety.
Tax Qualified (TQ) Policies: Beginning January 1,
1997, long-term policies meeting certain requirements qualify for
favorable tax treatment. Buyers of these plans may deduct the premiums
if they itemize their deductions on their Federal Tax return. Premiums
are treated as medical or health insurance expenses and must be equal
to more then 7.5% of adjusted gross income. Also, benefits received
from a Tax Qualified Plan (TQ Plan) are not taxable up to $175.00
a day.
Transition Expense: Expense incurred during the time
you are waiting for Home Health Care.
Transition Expense Allowance: Set amount of funds
paid during the waiting period, which may be used for in home equipment.
Underwriting Process: Steps through which an insurance
application is reviewed by a licensed insurance counselor to become
approved for insurance.
Unique Features: Benefits, options, and advantages
that are particular to an insurance carrier.
Validity of Claim: Judgment passes on claim from
house claims department, which verifies that the claim is accurate
and truthful.
Waiting Period: Period of time lost while waiting
for Home Health Care.
Waiver: An agreement attached to the policy that
exempts from coverage specific disabilities and injuries that normally
would be covered under the policy.
Written Premiums: The total amount of premiums due
in a year for all policies issued by an insurance company.
A condition that is verified by a physician that renders the individual unable to perform at least two of the activities of daily living (ADL's) for at least 90 days, which requires the individual to have substantial supervision to protect themselves from threats to health and safety
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Understanding the Terminology: It is our hope to provide you with the information you need to make an educated decision in regards to purchasing Long Term Care Insurance. We fully understand that this type of insurance can seem complicated, and we hope this glossary will help, by familiarizing you with the most common terms and ideas involved. If after looking through this web site you are still unsure, feel free to contact us, so that we can answer your questions. |