Did you know that long term care policies are not just for nursing home coverage?  They can also be used to help pay for home care costs as well!  If you aren’t sure where to start to activate your policy, below is a great guide to assist you with activating your long term care policy!

To Start the Claim Process

• Start the process by contacting your long term care insurance company to determine what you need to start a claim.  Often this includes a nurse assessment.  This is sometimes from the insurance company or the Home Care Agency to ensure you are eligible for benefits
  • Long term care policies generally require that assistance is needed with a minimum number (usually 2 or 3) of ADL’s (Activities of daily living), or have significant cognitive impairment such as dementia requiring supervision.  The following are the most common:
    • Bathing (personal hygiene, grooming, could be as simple as a stand by shower to ensure you don’t fall)
    • Dressing
    • Transferring and Ambulation (or help with safe movement)
    • Toileting (activities related to using the restroom – it could be just assisting them to restroom or help with depends)
    • Eating (feeding)

Know What You Qualify For

• In addition to starting the claim and being qualified, you will want to know what benefits you qualify for.  Policies are all different but they will typically have 3 things to focus on:
  • A daily dollar limit (most common), or daily hours limit (depending on policy).  This is not always the amount that is stated on your policy documents, and can often be much more, thanks to an inflation rider
  • An inflator – which factors in inflation.  You may have a 5% inflator, so if your policy allows a daily payout of $100 this year, it will allow for $105 next year to help account for the rising costs of living.
  • A lifetime benefit maximum
  • Elimination period (will discuss this below)

• Insurance companies generally require additional information from the Home Care Agency.  This is usually a copy of the license, and sometimes a care plan.
• Insurance companies typically require you to authorize the Home Care Agency to speak with them on your behalf.

It is important to work with an expert when activating a long term care policy

Elimination Period

• Usually after you are approved to start using your long term care policy, there is an “elimination period” which needs to be met before the policy will start to pay out.  This is basically to prove that you do in fact need these services, and aren’t trying to activate the policy so family can go on a 3 week cruise across Europe.
• The elimination period varies by policy, and the definition of days varies by policy.  While there are some plans that require zero days of elimination, we typically see 30-90 days.
• Elimination periods might be able to be shortened if you have had an event that required hospitalization or skilled nursing care.  For example, if you fell and required physical therapy, some insurance companies might be willing to take that as evidence that you do in fact need personal care.

It is important to work with a home care provider such as Assisting Hands that has worked with long term care and knows how to activate your long term care policy.  We are experts with Banker’s Life, John Hancock, Genworth and many others!  If you would like to learn more, please call us today at 239-337-4263.