The Insurance Contract

When you purchase a long term care insurance policy, you are entering into a contract with an insurance company to pay benefits should you require care as defined by the policy.

The benefits paid may be either a reimbursement of your expenses up to the daily maximum you select or an indemnity benefit, which pays you the stated amount you purchase for each care day.  A policy can be designed to cover you as an individual or benefits can be combined with your spouse in a "shared" policy.  Like most insurance, you determine the overall coverage limits and deductibles. 

Nursing Home Claims by Diagnosis1
Alzheimer’s	27%
Stroke	13%
Circulatory	10%
Injury	10%
Arthritis	8%
Cancer	7%
Nervous Syst.	6%
Respiratory	5%
Mental	2%
Other	12%

For more information on benefit options and costs, please visit our page on policy costs.

How are benefits triggered?

 

Long Term care policies are designed to pay benefits for care you receive as the result of an accident or illness.  Tax-qualified polices, the most common offered today, will pay benefits if at least one of the two following "benefit triggers" are met:

  

You claim is generally a collaborative effort between you, your Doctor and the insurance company.  The company will pay benefits directly to you based upon an approved "plan of care" submitted by your Doctor.

Home Care Claims by Diagnosis1
Alzheimer’s	17%
Cancer	15%
Arthritis	15%
Stroke	11%
Injury	11%
Circulatory	8%
Nervous Syst.	7%
Respiratory	4%
Digestive	2%
Other	9%

 

For example, your doctor says that due to your cognitive condition, you require 4 hours per day of custodial care. Once approved, the company pays you for that care based upon the terms and limits stated within your policy.

  

This is an excellent time to rely upon your agent to guide you through the porcess and advocate on your behalf.