Long term care insurance benefits can vastly increase the amount of long term care you can afford, so be sure to understand and utilize them! This article will give you tips to get you started. Read your long term care insurance policy carefully. There are many different types of policies and many options are available, so be sure you know exactly what your particular policy covers. Also, consult your insurance advisor to explain any technical terms, answer your questions, and give you advice about the best way to utilize your benefits. If your long term care provider has offered to file claims for you, be sure you understand your benefits and the filling process, in case your provider doesn’t. The National Association of Insurance Commissions publishes a handy guide called A Shopper’s Guide to Long Term Care Insurance, which you can download at this link from the NAIC website. The remainder of this article is based on that guide; we recommend you also consult the guide directly. Some policies also provide “pooled” benefits (also called “joint benefits”) that are shared between related adults. Covered services vary by policy, so be clear about what your policy covers typical options include: Some policies only cover services provided in certain geographical areas. Most policies issued in the United States do not provide coverage outside the United States. Be clear on what particular services your policy doesn’t cover. These exclusions will be listed in the policy. Policies normally pay benefits by the day, week, or month. Some policies pay one time for single events. Most policies limit the total benefit amount that they will pay over the life of the policy. Some policies state the maximum benefit it terms of a time period such as year; others will specify a maximum dollar amount paid. Some policies will include inflation adjustments which increase the benefits for inflation. Some of these policies include automatic inflation adjustments, either using simple or compounded adjustments. Others offer non-automatic offers to increase benefits, usually accompanied by a change in premium. You become eligible to receive benefits under your policy when you meet the requirements of the “benefit triggers” in your policy. Typical benefit triggers include the following, but your policy will be specific about its benefit triggers: Many policies don’t pay benefits right away - they have an elimination period, deductible, or waiting period. Elimination periods for different services may be different even when covered within the same policy. Some elimination periods are stated in terms of calendar days; others are stated in terms of service days. Some require measurement in consecutive days; others allow non-consecutive days. Some policies require you to meet the elimination period only once in your lifetime. Others have a new elimination period for each episode of care. Determine if your policy includes: As you make your plan for long term care, consider the type of coverage provided in your policy. The article at this link will show you how to make your plan. Your benefits may become necessary due to a sudden accident or illness or due to increasing cognitive impairment. Therefore, be sure your loved ones and trusted advisors are aware of your policy and have a copy of it. This includes your agents under health care power of attorney and general (financial) power of attorney, your financial advisors, and loved ones who may feel responsible for caring for you. Your insurance company may not be willing to speak with anyone about your benefits unless they can prove they are your agent under power of attorney or unless you give specific permission. In addition, it is helpful to tell the insurance company who to contact if your coverage is about to end because you forgot to pay the premium. This is often called “third party notice.” The insurance company will have specific requirements for how claims are filed. Contact your insurance company or your insurance advisor to learn the process and obtain the proper forms. It’s a good idea to keep a log of your conversations and contacts with the insurance company and keep all the claim paperwork, in case there is a dispute later. The insurance company will probably have a nurse or other professional assess your loved one’s needs to determine if they meet the policy’s benefit triggers - both when the initial claim is filed and periodically thereafter. We recommend that you or your care manager be present with your loved one to ensure the assessment is accurate. Often, potential beneficiaries will overstate their abilities out of pride or out of unrealistic beliefs in their current capabilities, which could cause coverage to be incorrectly denied. Filing long term care insurance claims can sometimes be complicated. Consult your insurance professional. Also, you can hire long term care insurance claims specialists to process claims on your behalf and to help you dispute claims that are denied. Need help utilizing your long term care insurance benefits? Care is There can:Understanding the Benefits in Your Particular Policy
Know How Your Benefits Are Paid
Know What Services are Covered
Know the Requirements that Service Providers Must Meet
Know Where Services are Covered
Know What Services Are Not Covered
Know How Much Coverage You Have
Know How You Become Eligible for Benefits
Know When Benefits Begin
Be Aware of Other Aspects of Your Policy
Tips from Care is There
Planning Care Based on Your Long Term Care Insurance Benefits
Be Sure Your Loved Ones and Advisors Are Aware of Your Policy
Know How to File a Claim
Be Present with Your Loved One During Needs Assessments Conducted by the Insurance Company
Get Help When You Need It
How Care is There Can Help
Next Steps
Contact Care is There today for a free consultation!
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