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Services covered by Insurance Policies

Insurance policies describe where they would pay for the care, what kind of care they would pay for, or who could provide the care, and even the conditions that have to be met before a company would pay benefits. Described below are the services required in a long term insurance policy accepted under current state California law. You must be aware however, that California law has changed many times over the recent years, and that insurance policies sold in previous years might have different requirements than are shown here.

Facility Coverage: In California, up most skilled, intermediate and custodial care is received in nursing homes, which are licensed as “skilled nursing facilities”. All long-term insurance policies except “Home Care Only” cover this kind of care.

Policies sold after October, 2001 (except “Home Care Only” insurance policies) are essential to include a benefit to cover insurance care in an assisted living facility licensed as a Residential Care Facility for the Elderly (RCFE).

Some Long term insurance policies sold before October, 2001 also include this benefit. RCFE’s are not nursing homes, but living arrangements where a person will also receive personal care or supervision. Some RCFE’s are large retirement homes, whereas others are small group homes.

Home Care Coverage: Every long term insurance coverage known as “Home Care Only” or “Comprehensive Long-Term Care” issued after January 1, 1993 should include at least the following 6 Home Care benefits and other consumer protections which must make it easier to receive care at home.

1. Home Health Care is most skilled nursing care or other professional services in your residence.

2. Adult Day Care is medical or other social care in a daytime plan, a licensed facility that provides personal care, supervision, protection, or assistance in the following: eating, bathing, dressing, moving about and also taking medications.

3. Personal Care is assistance with any of the Activities of Daily Living or ADLs as well as other Instrumental Activities of Daily Living (IADLs) such as using the telephone, managing medications, moving about outside, shopping for essentials, preparing meals, doing laundry and also light housekeeping. Under California state law, these services might be provided by a skilled or unskilled person providing they are required in a Plan of Care developed by your doctor or a team of health insurance workers under medical direction.

4. Homemaker Services helps you out with tasks or activities such as cooking, cleaning and other activities to help you stay in your home.

5. Hospice Services are services in your residence specially designed to provide physical, emotional, social and spiritual support for you, your caregiver and your family when any terminal illness has been diagnosed. Some insurance policies would pay for these services in an institutional setting as well. Under California law, these insurance services (like Personal Care) might be provided by a most skilled or unskilled person so long as they are required in a Plan of Care developed by your doctor or a good team of health care workers under medical direction.

6. Respite Care is short-term insurance policy provided in a nursing facility, in your home or in your community based health plan that is designed to relieve the primary care giver in your home.

For more informations on our services contact insurance brokers John Good | Kelly Good