All other factors being equal, which of the following long-term care policies will have the highest premium?
A policy with no elimination period
Ge... [Show More] nerally, long-term care is provided for
chronic conditions
The type of nursing home facility that provides the highest level of medical care and that tends to be the most expensive is
the skilled nursing facility
Care that does NOT involve medical services and that is primarily provided to meet personal needs, such as help in walking, bathing, eating, and dressing, is
custodial care
In California, a long-term care policy may be called comprehensive long-term care insurance if it provides LTC benefits for
both institutional care and home care
All other factors being equal, which of the following long-term care policies will have the highest premium?
A policy with no elimination period
In California, when must a long-term care insurance policy provide benefits for home care services provided by unlicensed providers?
When the state has no licensing requirements for those particular services and the policy covers them
Long-term care benefits designed to provide coverage of _______ or more that are contained in Medicare supplement or other disability policies are regulated as long-term care insurance.
12 months
Under Jill's long-term care insurance policy, the insurer cannot refuse to renew and cannot change the terms of coverage as long as Jill pays the premiums on time. The insurer can change the premium for an entire class of insured, but it cannot change the premium rate for an individual insured at renewal. Jill's policy is
guaranteed renewable
The type of care that is provided under a medical treatment plan and only by, or under the supervision of, a registered nurse is
skilled nursing care
No group long-term care coverage under a group policy issued in another state may be sold to a resident of California unless the insurer has filed specimen copies of the master policy and certificate, the outline of coverage to be used, and representative advertising materials with the Commissioner at least 30 days before advertising, marketing, or offering the coverage in California.
Continuation coverage means continuing the coverage under the existing group policy when it would otherwise terminate, subject only to the insured's timely payment of premiums. If a person's eligibility for group coverage is based on the person's relationship to another individual, the person is entitled to continuation coverage under the group policy if the qualifying relationship terminates by death or divorce. This right is protected under state and federal law, but if the employer was paying any part of the group premium, the insured becomes responsible for paying the full premium for coverage. Additionally, there may be limitations on the length of time an employer is required to continue coverage under the group plan.
Conversion coverage means an individual policy of LTC insurance, issued without evidence of insurability by the same insurance company terminating the group coverage and containing benefits that are identical or substantially equivalent to the group benefits being terminated. The premium for a converted policy must be calculated based on the insured's age when the group certificate that is being terminated was originally issued. If the employer was paying any part of the group premium, the insured becomes responsible for paying the full premium for coverage.
Home health care means skilled nursing care or other professional services provided in the insured's residence, including, but not limited to, part-time and intermittent skilled nursing services, home health aid services, physical therapy, occupational therapy, speech therapy and audiology services, and medical social services by a social worker. {Topics I.C.1.a.i, IV.C.3.a.i, V.A.3.d}
Adult day care means medical or nonmedical care on less than a 24-hour basis, provided in a licensed facility outside the residence for persons in need of personal services, supervision, protection, or assistance in sustaining daily needs, including eating, bathing, dressing, ambulating (walking), transferring, toileting, and taking medications. {Topics I.C.1.a.ii, IV.C.3.a.ii}
Adult day health care means adult day care that includes medical care, including skilled care and therapy services.
Personal care means assistance with the activities of daily living, including the instrumental activities of daily living, provided by a skilled or unskilled person under a plan of care developed by a physician or a multidisciplinary team under medical direction. Instrumental activities of daily living include using the telephone, managing medications, moving about outside, shopping for essentials, preparing meals, and doing laundry and light housekeeping. {Topics I.C.1.a.iii, IV.C.3.a.iii}
Homemaker services means assistance with activities necessary to or consistent with the insured's ability to remain in the insured's residence, which is provided by a skilled or unskilled person under a plan of care developed by a physician or a multidisciplinary team under medical direction. {Topics I.C.1.a.iv, IV.C.3.a.iv}
Hospice services are outpatient s not paid by Medicare that are designed to provide palliative care (care that reduces the consequences of a disease) in order to alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease and to provide supportive care to the primary caregiver and the family. Hospice care may be provided by a skilled or unskilled person under a plan of care developed by a physician or a multidisciplinary team under medical direction. {Topics I.C.1.a.v, IV.C.3.a.v}
Respite care means short-term care provided in an institution, in the home, or in a community-based program, which is designed to relieve a primary care giver in the home. Respite care gives family members who are caring for an insured a temporary period of rest or relief. This is a separate benefit with its own conditions for eligibility and maximum benefit levels. (CIC 10232.9.b.1-6) {Topics I.C.1.a.vi, IV.C.3.a.vi}
a non-Medicaid state or national long-term care program is created through public funding that substantially duplicates benefits covered by an insured policy or certificate, the policyholder or certificate holder will be entitled to select either a reduction in future premiums or an increase in future benefits. An actuarial method for determining any premium reductions and benefit increases will be mutually agreed upon by the Insurance Department and insurers at that time. The amount of the future premium reductions and benefit increases to be made by each insurer will be based on the extent of the duplication of covered benefits, the amount of past premium payments, and claims experience, and each insurer's premium reduction and benefit increase plans will have to be filed and approved by the Department. (CIC 10235.91)
Buyers of long-term care insurance in California are entitled to a trial examination period, also known as a 30-day free look. An applicant for long-term care insurance has the right to return the policy within 30 days after delivery and have the premium refunded if not satisfied for any reason. Such return voids the policy from the beginning, leaving the applicant in the same position as if the contract had never been issued. A notice stating this right must be printed on the first page of every policy or certificate or be attached to it.
nursing facility must cover and reimburse for per diem expenses, as well as the costs of ancillary supplies and services, up to but not to exceed the maximum lifetime daily facility benefit of the policy or certificate.
Every long-term care policy must cover preexisting conditions disclosed on the application no later than ______ following the effective date of coverage.
6 months
Buyers of long-term care insurance in California are entitled to a free-look period of
30 days [Show Less]
