Understanding Your Long-Term Care Policy
This is a simple guide to LTC. Other factors can be important, but the information below should be considered by the individual and families filing a Long-Term Care insurance claim:
Care Needs & Activities of Daily Living (ADL) – most LTC policies require deficiency in two or more ADL. The insurance company will arrange a virtual or face-to-face evaluation to assess the proficiency in these areas.
- Bathing – Capable of bathing independently with exception of one area (feet, back, etc.)
- Dressing – Select clothes from closet, dresser and appropriately dress.
- Toileting – Go to bathroom without help on and off toilet, redressing and cleaning.
- Transferring – Get in and out of chair, bed, shower without assistance.
- Continence – Complete control over urination and defecation.
- Feeding – Transferring food from dish to mouth without assistance.
In evaluation of a claim, insurance companies may consider individual proficiency in IADL – Instrumental Activities of Daily Living:
- Using a telephone
- Shopping
- Food Preparation
- Housekeeping
- Laundry
- Transportation
- Managing Medications
- Managing Finances
Individuals and families should understand the financial terms of their policy and how that impacts their financial obligations. It is critical to know:
- Exclusion Period – Most policies have a 30/60/90-day period where the claimant must pay for services out of pocket before the benefit payments start. Generally, the exclusion period can begin before the claim is filed/approved.
- Daily Benefit Amount – The policy will pay a specific dollar amount per day of service.
- Cost of Living Adjustment – Many policies have a set annual cost of living increase.
- Lifetime Benefit Maximum – Many policies have a maximum amount the insurance company will pay on the policy in the claimant’s lifetime.
If you or your family have questions, the FirstLight Home Care team is available to help you navigate the claim process.