There are different types Long Term Care Insurance Policies. “Indemnity” or “Expense Incurred” policies are most common. When you buy an expense incurred policy, you choose the benefit amount. Regardless of what you spend an “indemnity” or “per diem” policy pays up to a fixed benefit amount. An “indemnity” or “per diem” policy reimburses for the actual expenses for services received up to a fixed dollar amount per day, week, or month.
“Integrated Policies” or policies with “Pooled Benefits” pay a total dollar amount which may be used for different kinds of long term care services used. There is usually a daily, weekly, or monthly dollar limit for long term care expenses covered by this kind of policy. For example you buy a policy with a maximum benefit amount of $300,000 of pooled benefits. You will have, with this policy a maximum daily benefit of $300 that would last for 1,000 days if you spend the maximum daily amount on care. If your care costs less than the maximum daily amount of $300 you will receive benefits for more than 1,000 days.
According to where benefits are paid Long Care Insurance Policies are divided into three broad categories – Home Care Only, Nursing Home and Residential Care Facility Only and Comprehensive. Home Care Only policies cover care in your own home or a community setting. It does not cover care in Assisted Living Facilities or Nursing Homes. It includes benefits for home health, adult day health care, hospice, respite care, personal care and homemaker services.
Nursing Home and Residential Care Facility Only policies cover care in a nursing home or any place that provides assisted living care as long as this place is licensed as a Residential Care Facility for the Elderly (RCFE). The benefit of this kind of policy is not the payment for room and board in these facilities. The policy benefits include coverage of all long term care services you receive in either of these facilities up to the policy’s maximum daily benefit amount.
Some of the RCFE include small neighborhood homes also called board and care facilities, retirement homes and specialized community facilities for patients with cognitive impairment (dementia) from Alzheimer. In this kind of policy, the assisted living benefits must equal to at least 70% of the nursing home care benefit.
Comprehensive Long Term Care Insurance Policies provide coverarge for costs rising out of care in a nursing home, assisted living facility, home care and community care (adult day care). Different companies require different criteria to be met before benefits can be paid by LTC Comprehensive policies. Comprehensive Long Term Care Insurance Policy will pay you benefits when two activities of daily living (such as bathing, using the bathroom, dressing eating etc.) can not be performed or you have a cognitive condition that requires supervision. The criteria required for the benefits remains same whether care is provided at your own home, in a nursing home, or in an assisted living facility.
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