Long Term Care Insurance: How and When Can Policies be Activated?
As more of our society moves into retirement age, the options for covering the increasing costs of long term care are becoming a hot topic of conversation. Long Term Care (LTC) Insurance is designed to help with the financial burden associated with skilled nursing, assisted living communities and in-home care. LTC policies offer a wide variety of coverages, but most provide a set dollar amount for daily care needs that begins following an elimination period of 30, 60, or 90 days where the client or other resources must pay for the care.
LTC insurance policies can be confusing and difficult to navigate as each has its own set of eligibility rules. Measuring a person’s functional abilities has become the standard practice for determining if an LTC insurance policy should be activated. The insurance company will begin by asking if the insured has difficulties with any Activities of Daily Living (ADL’s) and/or cognitive deficits. ADL’s are assessed by six different criteria: ambulation (movement), dressing, toileting, eating, bathing and continence. Most policies require policy holders to require assistance with two or more ADLs in order for benefits to be triggered. Cognitive deficits, such as a diagnosis of Alzheimer’s, may also trigger activation of a policy.
A Geriatric Care Manager, such as the one available at the Elder Law Offices of Barry Meyers, can assist with both the process of determining when to apply for LTC benefits as well as the actual application process. Once an LTC claim is initiated, a representative from the insurance company will be assigned to determine if there are enough triggers to activate the policy. If the representative determines the policy is eligible to be activated a list of required information and documentation will be provided to the client. The required paperwork varies from company to company, but may include: invoices from care provider(s), physician statement(s), release of information forms and a statement of personal information from the insured. The insurance company will also schedule a nurse evaluation at the insured’s place of residence to help develop a care plan. If someone other than the insured is completing the required forms, the appropriate legal documents giving authorization (such as a power of attorney) must be included. Once completed, the paperwork and documentation is then returned in its entirety to the insurance company who will make an eligibility determination.
There are many different LTC policies and plans, but activating these plans starts with a phone call to the right department. Are you prepared to start this process? Do you know where to begin and who to contact? Services and resources are available to lessen the stress. The Elder Law Offices of Barry Meyers is an excellent source for families needing both legal and practical advice on Long Term Care. Our unique team composed of both lawyers and a Geriatric Care Manager offers clients the breadth of expertise that is often needed to navigate the tricky waters that can come with aging and disabilities.
Kaaran Anderson, RN
Geriatric Care Manager
Barry M. Meyers
David M. Neubeck
Elder Law Offices of Barry M. Meyers, P.S.
DISCLAIMER: The content of this newsletter is: for information purposes only, subject to change by government agencies, should not be relied upon as current, and, does not constitute legal advice. Reading this newsletter does not establish an attorney-client relationship.