Designing a Long Term Care Policy

1. Designing a Long Term Care Policy

2. The Very First Thing To Do • Personal Health History • Age • Health of self, parents, & siblings • Marital status • List of medications • Drug • Dose—how much, how often • Why?

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

4. What Type of Policy?

5. 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

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

7. Nursing Home Assisted Living Facility Alzheimer’s facilities Nursing Home Assisted Living Adult Day Care Home Care Caregiver training Facility vs Comprehensive

8. 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 req’mts Loss of 1 of 7 (mobility) Medical Necessity Cognitive Impairment No time req’mt Some require plan of care, some don’t Premiums not deductible Qualified vs. Non-Qualified

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

10. 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 How Much Coverage?

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

12. 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

13. 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?

14. 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 Individual vs Group