Activities of Daily Living – Personal care activities that may include bathing, dressing, eating, transferring, toileting, continence and mobility.
Acute Care – Critical care provided by a doctor or other health care professional designed to treat or cure an illness, wound, or condition. This care is usually received in a critical care facility such as a hospital or acute rehabilitation center. Long term care is not acute care.
Adult Day Care – A program that provides activities and services to individuals in need of long term care. Adult care centers provide care for less than 24 hours a day.
Alternate Care Benefit – A special arrangement of services specifically designed to allow the insured in a setting other than a nursing facility. It may be any combination of: services to provide assistance to the insured, e.g., Home Health Care, Home Improvements and Durable Medical Equipment.
Assisted Living Facility – A residential facility that provides room, board and 24-hour personal care to individuals with long term care needs. It is a care option for individuals who are not able to manage at home, but do not need the level of skilled care provided in a nursing home. It may also be called a Custodial Care Facility.
Bed Hold Benefit – If the insured’s stay in a Nursing Home or Assisted Living Facility is interrupted because they are hospitalized, the insurance company continues to pay benefits to assure a place is reserved. The length of the benefit varies by carriers.
Benefit Amount (Daily/Monthly) – The maximum amount that an insurance company will reimburse an insured per day or per month for long term care expenses.
Benefit Period – The length of time that the insured has coverage for.
Calendar/Service Days – The number of days the insured must wait before they become eligible to start receiving benefits. With calendar days it is consecutive, even if no care is provided by a licensed provider on that day. For service days, only days that actual care is provided by a licensed provider are counted.
Care Advisory Services – Assessment and care planning by a Home Health, a Care management Organization or an Independent Care Manager.
Care Coordinator – Licensed health care practitioner employed by or contracted with the insurance company to provide services which may include:
- A face to face assessment of the insured’s need for long care services
- A written plan of care
- Monitoring the delivery of services as may be appropriate.
Caregiver – A person who helps the insured to accomplish the basis everyday activities they can longer manage without assistance; due to illness, injury cognitive impairment.
Care Management Organization – An organization that is licensed, if required, and operated to provide Care Advisory Services according to the laws, if any, or the jurisdiction in which it is located.
Cognitive Impairment – A deterioration or loss in intellectual capacity that results in impairment in some or all of the following; short and long term memory, orientation to people, place and time., deductive or abstract reasoning (including judgement).
Community Based Professional Care – Home health care, homemaker services, personal care, respite care, and hospice care rendered by a qualified provider in your home or adult day care provided in a qualified adult day care center.
Coordination of Benefits – Benefits available in an individual or group long term care policy may coordinate with other insurance policies or government programs such as Medicare and Medicaid. Individual and group do not cover services, including co-insurance or deductibles when Medicare is covering those expenses.
Covered Charges – Expenses incurred that are covered by a long term care policy. Typically, covered charges include such things Home Health Care, both skilled and custodial, room and board in an Assisted Living Facility or Nursing Home.
Custodial Care – Non-skilled long term care services aimed at maintaining your health.and or preventing further deterioration in the insured’s functional status.
Daily Benefit – The maximum amount your long term care insurance will pay in a given day.
Date of Service – A day the insured is eligible for benefits with their insurance policy.
Durable Medical Equipment – Item(s) the insured can rent or buy designed to be used in the home to assist them in performing the Activities of Daily Living.
Elimination Period – The period of time in which the insured has to pay their own long term costs before becoming eligible for coverage. The insurance plan may use either a calendar or service day elimination period.
HIPPA (Health Insurance Portability and Accountability Act) – Federal health insurance legislation passed in 1996 that sets standards for long term care insurance policies to meet in order to qualify for federal income tax advantages.
Home Health Aide – Licensed non-medical professional who provides custodial care in the insured’s home.
Home Health Care – Licensed medical and non-medical professionals who provide personal care services in the person’s home. Home Health care may include occupational, physical, respiratory or speech therapy, as well as custodial and/or nursing care.
Home Modfication – Physical modifications to a home that enable a person to stay and function in the home (e., chair lift).
Homemaker Services – The non-medical and incidental support services that are needed so a person can remain in their own home: meal preparation, laundry, light housekeeping.
Hospice Care – Care intended to alleviate the physical, emotional or spiritual suffering near the end of life.
Licensed Health Care Practitioner – A physician, a registered nurse (R.N.), a licensed certified social worker (LCSW), or any other individual who meets the requirements by the Federal government.
Lifetime Maximum Benefit – The total pool of money payable for covered medical long term care expenses while insured.
Long Term Care (LTC) Insurance – Personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. Long term care can be provided at home, in a nursing home, assisted living facility or an adult day care center.
Medicaid – The joint Federal-State program that pays for health care services for individuals who meet their state’s poverty guidelines.
Medicare – A federal health care program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.
Monthly Benefit – The maximum amount the policy will pay for long term care expenses in any month.
Non-Duplication of Benefits – The insurance policy only pays covered charges in excess of the charges covered under Medicare (including amounts not reimbursable by Medicare such as a Medicare deductible or co-insurance amounts), other government programs (excluding Medicaid) or any state or federal worker’s compensation, employer’s liability or occupational disease law.
Nursing Care – Skilled or intermediate care provided by the following types of medical professionals: Registered Nurse (R.N.), Licensed Vocational Nurse, Licensed Practical Nurse, Physical Therapist, Occupational Therapist, Speech Therapist, Respiratory Therapist, Medical Social Worker or Registered Dietician.
Nursing Home – A licensed facility that provides 24-hour-per-day room and board, nursing care and personal services. Nursing homes also provide medical care, therapy and other health related services.
Plan of Care – A plan prescribed by a licensed health care practitioner that identifies services that meet the insured’s needs.
Policy Limit – The total amount from which the insured will be paid benefits for all covered care and services.
Respite Care – Short term care designed to provide temporary relief to the primary caregiver. The care may be provided in a skilled nursing facility, assisted living facility adult care or the insured’s home.
Restoration of Benefits – Policy provision that if the insured is no longer eligible for benefits after a specified number of consecutive days, the company restores all or part of the policy benefit.
Skilled Nursing Care – Nursing care that is performed by skilled medical personnel. It can be either in a facility setting or at home.
Skilled Nursing Facility – Generally a state licensed institutional setting that provides skilled care by skilled medical personnel. The care is available 24 hours a day and is requested by a physician under a treatment plan.
Substantial Assistance – Hands-on or standby assistance from another individual while you are performing the activities of daily living.
Waiver of Premium – Policy provision that waives all future premiums on the insurance policy once the insured is certified to be eligible for long term care.