There are various Long Term Care Insurance Policies. The most popular are the “Indemnity” or “Expense Incurred” where you choose the benefit amount. A fixed benefit amount is paid by an “indemnity” or “per diem” policy regardless of what you spend. The actual expenses for services received up to a fixed dollar amount per day, week, or month is reimbursed with an “indemnity” or “per diem” policy.
“Integrated Policies” or policies with “Pooled Benefits” offer a total dollar amount which may be used for different kinds of long term care services. Usually there is a daily, weekly, or monthly dollar limit for long term care expenses covered by the policy. Let’s say for example you buy a policy with a maximum benefit amount of $300,000 of pooled benefits. With this policy you will have a maximum daily benefit of $300 that would last for 1,000 days if you spend the maximum daily amount on care. You will receive benefits for more than 1,000 days if your care costs less than the maximum daily amount of $300.
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.
Costs rising out of 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) is covered by Nursing Home and Residential Care Facility Only policies. This policy pays for more than just room and board in these facilities. The costs of all long term care services you receive in either of these facilities is paid by this policy up to the policy’s maximum daily benefit amount.
Care for patients with cognitive impairment (dementia) from Alzheimer is provided in small neighborhood homes also called board and care facilities, retirement homes and specialized community facilities which are part of the RCFE. This kind of policy provides for assisted living benefits equallingl to atleast 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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