by julietegecy » Tue Dec 15, 2009 07:22 am
I am planning to go for Long Term Care Insurance before purchasing policy I was reading few articles on it. But I am not able to understand the term “Elimination Period”. Could anyone please explain what is Elimination Period?
Posted: Tue Dec 15, 2009 11:19 am Post Subject:
The elimiation period is the number of days that one must receive care before the policy can start paying benefits. ex. Juliet has a 90 day elimination period. She gets hurt/sick and starts to need care. The policy won't pay anything for the first 90 days.
Posted: Tue Dec 15, 2009 01:57 pm Post Subject:
Only one minor mistake above. The ELIMINATION PERIOD is the period of time from the onset of a disability until benefits become payable. "Receiving care" is not technically a requirement of an LTCI policy, unless the policy is less than comprehensive (facility-only/home-care only). You should be considering a comprehensive policy with inflation protection.
In LTCI, a medical professional (MD, DO, NP, or MSW, possibly an RN) must certify that a person has a hands-on or stand-by need for assistance due to an "impairment" in two or more of the six activities of daily living (ADLs). To receive benefits, a comprehensive LTCI policy does not require prior hospitalization nor does it require admission to a nursing facility. (A facility-only policy is different because it only pays benefits for care in an institutional setting).
The two affected ADLs might not require "care" at all. Just assistance. So if diagnosed/certified with an "impairment", the elimination period is a "time deductible" -- the amount of time you must wait until benefits are payable. 0 - 30 - 90 - 100 - 180 - 365 days are all common elimination periods. The longer the elimination period, the lower the premium for the same daily benefit.
The six ADLs, by the way, under federal law for a "tax-qualified" LTCI policy are: eating - dressing - bathing - toileting - continence - transferring.
Posted: Tue Dec 15, 2009 09:11 pm Post Subject:
Max, you are doing it again.
Do you make up answers for the fun of it? Whether one has "hands on" or "stand by" assistance, they are still receiving care. What must happen is that the person is certified to be "chronically ill". This means that one can qualify for benefits without needing assistance with ADL's since the definition includes cognitive impairments. There also must be the expectation that care will be needed for 90 days.
Different policies count the days of the elimination period differently. Juliet, if a policy has an elimination period of less than 90 days, that doesn't necessary mean that one will be able to collect on a shorter term illness/injury.
Posted: Tue Dec 15, 2009 09:20 pm Post Subject: insurance
This is really 'odd' I came across THIS thread. The reason? ..because a co-worker and myself were talking about this today. She has to put her mother into a Nursing Home and she has pamplets, from the Nursing Home explaining 'Long Term Care', etc. ONE of things things, this pamplets states is the "Elimination Time in which..." MAX's explanation IS correct on this one. I read it myself.
Posted: Tue Dec 15, 2009 10:02 pm Post Subject:
Yes, Alzheimer's disease and other "cognitive impairments" are entirely separate qualifying events, and the elimination period begins running with the diagnosis, even if it truly does not require any specialized care at the moment. Yes, the phrase "chronically ill" is obviously important, too. "Stand-by" assistance -- which can be as limited as simply observing while a person is getting dressed or getting into and out of the tub or shower to bathe. for example, in case they might lose their balance and are in danger of falling is not exactly "care." But this is all splitting hairs, semantically.
As far as counting off the days of the elimination period, some older policies that Genworth and a couple of other companies issued in the early 2000s initiated provisions that if a person was receiving "care" under a plan of care devised through their Care Coordinator program (third-party MSW/RN assessment) in a home care/community care setting, Genworth would credit 1 day of care as 7 days of the standard elimination period, so a 90-day elimination period could be satisfied in less than two weeks. It was an incentive to use their Care Coordinator, who also had the ability to negotiate savings on behalf of the insured.
Similar provisions are now found in many LTCI policies.
It's also important to note that the elimination period in LTCI policies is a lifetime elimination period. Once satisfied, it is over and done with. It is not a "per event" thing as in disability income insurance.
But as has been said in other threads, once you need it, it's too late to get it, so LTCI is something middle income folks -- the group most likely to be adversely affected by an LTC event -- need to put on their radar screens at about age 45. Sooner for some due to family history.
Posted: Wed Dec 16, 2009 03:54 am Post Subject: insurance
Good explanation..thank you. Yes..I deal with a few 'Clients' that are in the 'late' stages of Alz. It's really sad to see.....they don't know who we (aids) are, they don't know their children anymore, etc.
Posted: Wed Dec 16, 2009 11:17 am Post Subject:
I've never seen such an intelligent person be consistently wrong about so many things. Max, is it safe to assume that you haven't sold that many long term care policies? At the very least, you have never been involved with any claims? If you have been selling policies, I sure hope that you have a good E&O policy.
You are 100% incorrect on the "1 in 7" provisions. In most policies, in order for a day to count, two things must happen. 1)The person must be considered "chronically ill" and 2)The person must be paying for care.
Ex. Jim has a LTCi policy with a 90 day elimination period. His wife is taking care of him 3 days a week. She is paying for help 4 days a week. It will take 154 days to satisfy the 90 days if it doesn't have the "1 in 7" provision. The "1 in 7" provision will allow every week in which she pays for care 1 day to count as 7 days. This provision will allow the 90 day elimination period in this example to be satisfied in 90 days.
Max, if your goal is to provide people with correct information, please stop posting when you don't know the answer.
Posted: Wed Dec 16, 2009 05:40 pm Post Subject: insurance
How is MAX incorrect, when I had someone else tell me that same information? Is this OTHER person wrong, as well? Mmm......I really don't thinak so. Anyway......MAX, your info, on this Forum, is very valuable...thank you, again.
Posted: Thu Dec 17, 2009 12:34 am Post Subject:
SDchargersfan,
Look at a contract and you'll see that I'm correct. It's obvious that Max hasn't really sold any LTCi.
Posted: Thu Dec 17, 2009 02:16 am Post Subject: insurance
As I stated before, my 'Client's son DOES work for an Insurance Co. His advice was the same as MAX's advcie. His 'clarification' was very similiar. The son has been working for this Insurance Co for quite a long time...does very well at it, I may add. And, as I said before, MAX's advice and help is very valueable to me.
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