Designing a Long Term Care Policy

The Very First Thing To Do Personal Health History –Age –Health of self, parents, & siblings –Marital status List of medications –Drug –Dosehow much, how often –Why?

Gather Information before you decide on policy type or carrier Health Marital Status Financial Status –Assets –Income –Who will pay premiums?

What Type of Policy? Indemnity vs. Reimburse- ment Facility Only or Comprehensive One pot or Two Qualified vs. Non- Qualified

Indemnity Policy What you buy is what you get Not required to offset with Medicare Benefits up to $220 or to match expenses Claims may be easier to file

Reimbursement Policy Reimburses up to 100% of the daily maximum for services received Qualified reimbursement policies cannot pay if Medicare eligible

Facility vs Comprehensive Nursing Home Assisted Living Facility Alzheimers facilities Nursing Home Assisted Living Adult Day Care Home Care –Caregiver training

Qualified vs. Non-Qualified HIPAA Requirements Loss of 2 of 5 (or 6) or Cognitive Impairment Must be expected to last 90 days Plan of care Certification Premium tax deductible No contract reqmts Loss of 1 of 7 ( mobility) Medical Necessity Cognitive Impairment No time reqmt Some require plan of care, some dont Premiums not deductible

Looking for an Insurance Company Financial Stability –Large –Consistent rates Commitment to Long Term Care –In business at least 5 years

How Much Coverage? Insure the entire risk –$200 - $300 per day –Unlimited –Compound COLA –30 day elimination period Insure the short fall Daily benefit less –Social security –Less continuing income –4-6 year plan –90 day elimination

Contract Specifications Definitions – substantial assistance Verbal cueing Stand by Hands on 50% of the time Continuous hands on Certification by medical professional Yours Ours

Making compromises to save $$$ Higher daily amount vs. longest policy At older ages, simple rather than compound COLA Facility and Assisted Living without home care

Checking out the Nuances Is waiting period waived, or shorter in certain circumstances? Is bed reservation for any circumstance? Is waiver of premium for any benefit or only for facility? Is there a weekly or monthly maximum? How do home care days count? Actual days or other? Does help have to come from licensed facility?

Individual vs Group Individual Medically Underwritten More selection in benefits More discounts Benefit definitions may be less restrictive Payroll deduction and discount may be available Group Guaranteed Issue for active employees Limited plan choices Some carriers offer NS buy ups are allowed GI within parameters Payroll deduction always available