Health Insurance California >> Long Term Care >> Long Term Insurance Payment Conditions

Conditions to the Payment of Benefits

All insurance policies would require you to meet some “conditions” after the “benefit triggers” have been met and before insurance benefits would be paid.

Elimination Periods: The Elimination Period (sometimes known as “Waiting Period” or “Deductible Period”) is the period of time you must wait after you qualify for long term insurance, and are eligible to receive insurance benefits before the company would begin paying for your policy care. You choose the length of the Elimination Period when you purchase the insurance policy. The few common options are 0 days, 30 days, 60 days, 90 days or 100 days. Some insurance policies only make you meet the Elimination Period once during the life of the insurance policy; others apply it again after you have gone for some period of time without required care. In most situations the elimination period would be pleased by a day of either in home care or institutional care.

The premiums are generally more for short elimination periods and less for a longer one. Be sure to ask your specific qualified agent to explain these differences. The elimination or deductible period is the length of time where the insurer pays no benefits. If you select a 0-day Elimination Period, the insurance policy would begin paying on the first day you qualify for care. If you choose one of the other periods you would be responsible for paying the full cost of your care for these days.

If you qualify for benefits in a home care setting most long term insurance policies is applied in a day towards your Elimination Period for any day you actually get care (or a home care visit). Therefore, if your insurance plan of care only calls for 3 visits per week you would probable satisfy only 3 days towards your Elimination Period. Some companies offer even more liberal interpretation of this definition. For example, the policy may say that if you have one home care visit per calendar week, which you’ve satisfied 7 days towards your Elimination Period. In this example, you will surely satisfy your Elimination Period more quickly.

Several companies now make use of a calendar day definition for the elimination period. Once the insured has been certified as being constantly ill each calendar day counts towards the elimination period, in spite of it whether formal long term insurance policy services are received. This allows the insured person to receive informal care from family or friends during the elimination period. After the elimination period has been satisfied formal paid care could begin.

The premium cost is normally higher if you choose the shorter Elimination Periods and is very low if you choose a longer period. In addition a premium may also be higher when the company uses a more liberal “counting” of home care Elimination Period days. Also, make sure that the Elimination Period days, which are accumulated either in a home care or institutional care setting, are shared to satisfy your overall elimination period. Be sure to ask your qualified insurance agent to explain this.

Period of Care: A Period of Care generally begins on the first day you are qualified for benefits, and ends after a treatment free gap in which you do not need any other benefits. If you need care later, you might have to meet another Elimination Period.

Plan of Care: This is actually a plan written by your doctor or a medical team (such as a home health Agency’s health care team), which establishes your need for care, and describes the kind of care you really require, and the frequency of the required services. The Plan of Care is a well-known document to your doctor, hospital free planners, home health agencies and other health care providers who know about long-term insurance policy services. Many insurance policies also need that the Plan of care be updated occasionally to reflect any change in your need for care.

Care Management: Some insurance policies comprise Care Management features. A Care Manager might assess your condition, ask with your doctor, setting up a Plan of Care, follow your progress, and recommend care providers.

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