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LTC Staff
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on Thursday, 28 June 2012
in LTC Insurance

When Will I Be Eligible to Receive LTC Benefits?

It is very important to be aware of the requirements necessary to trigger benefits in the event that you need to file a Long Term Care claim. Guidelines vary, but can be found in the Outline of Coverage you will receive with your policy. The guidelines in your policy will have an impact on how easily you can qualify for benefits.

Typically, insurance companies require that the insured either cannot perform a certain number of activities of daily living over a period of time, has a cognitive impairment or that the insured’s doctor has certified that Long Term Care is a medical necessity for the patient. Requirements can vary between in-home care and nursing home care so be sure to read your policy.

The activities of daily living are the things we all do in the course of a normal day. Typically, they are bathing, dressing, continence, eating, toileting and transferring. A policy may stipulate that the insured must be unable to perform two or three of these tasks in order to qualify to receive benefits. Additionally, a policy may stipulate that the insured must need hands-on help to complete these tasks as opposed to stand-by help.

Usually, a Cognitive Impairment will immediately trigger benefits. This occurs when an insured is unable to pass certain tests of cognitive function and requires supervision and direction when completing the activities of daily living. Insurance companies will usually not make a distinction between needing hands-on care or stand-by care when a cognitive impairment is involved.

Some polices will also be triggered when the insured’s doctor certifies that Long Term Care is a medical necessity. This means the insured must require covered care due to sickness or injury. The care prescribed must be consistent with accepted medical standards for treating the diagnosed condition and the doctor must also certify that a lack of care would adversely affect the insured’s condition.

Since these requirements can vary from policy to policy, it is very important to know what your policy will require before you purchase it. If you would like to speak with someone about Long Term Care, please give us a call at 1-800-432-0091 or fill out our online form to request a free rate comparison.

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