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Long-Term Care Glossary


Activities of Daily Living

As defined below, a minimum of 2 of the 5 ADLs must be met to be considered claim eligible for Long-term care insurance:


  1. Bathing: washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.
  2. Continence: the ability to maintain control of bowel and bladder functions; or when unable to maintain control of bowel or bladder functions, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).
  3. Dressing: putting on and taking off all items of clothing and any necessary
  4. Eating: feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously. Eating does not include preparing a meal.
  5. Toileting: getting to and from the toilet, getting on and off the toilet,
  6. Transferring: moving into or out of a bed, chair or wheelchair. Transferring does not include the task of getting into or out of the tub or shower.

Benefit Period

The minimum number of years an insured is covered by the policy. The benefit period is also referred to as the benefit multiplier. The benefit period multiplied by the daily or monthly amount provide the insured with the benefit pool or policy limit.


Cognitive Impairment

Deficiency in a person's short-term or long-term memory; orientation as to person, place, or time; deductive or abstract reasoning; or judgment as it relates to safety awareness. Cognitive Impairment must be established and reliably measured by clinical evidence and standardized tests. The need for Substantial Supervision due to the presence of Cognitive Impairment must be established by such clinical evidence and standardized tests.


Compound Inflation

Will increase the Long-Term Care Benefit on each policy anniversary, the increase will be computed at the rate compounded annually and rounded to the nearest dollar. In other words, the Long-Term Care Benefit Amount in effect for the immediately preceding year will be increased by 5% and rounded to the nearest dollar.


CPI Inflation

CPI means the non-seasonally adjusted Consumer Price Index, Urban, all Items, published by the Bureau of Labor Statistics of the United States Department of Labor (CPI).


Custodial Care

Non-skilled long-term care which is necessary due to Cognitive Impairment; or to assist in the Activities of Daily Living.


Daily Benefit Policy

Benefits pay out based on a daily amount.


Elimination Period (a/ka waiting period)

The number of dates of service that would need to pass before benefits will pay.


Guaranteed Purchase Option

Will offer the insured the option to increase the Long-Term Care Benefit amount by purchasing an additional amount of coverage. No additional underwriting will be required.


Home

Primary residence, including independent living quarters in a continuing care retirement community or similar entity.


Home Health Care

Medical and non-medical professional or personal care services provided in home to assist in the Activities of Daily Living or to give supervision needed because of Cognitive Impairment.


Home Health Care Provider

Either a Home Health Agency or an Independent Home Health Care Provider that provides Home Health Care.


Hospice Care

A program for meeting care needs if one is Terminally Ill.


Immediate Family

Spouse or partner, or the following relatives: parents, stepparents, grandparents, siblings, children, stepchildren, grandchildren, and their respective spouses.


Long-Term Care Benefit

Will pay the actual charges incurred by the insured for Long-Term Care Services up to the Long-Term Care Benefit Amount.


Long-Term Care Services

The following covered care or services:

  1. Confinement in a Nursing Home or Assisted Living Facility for room, board and care
  2. Home Health Care, Hospice Care, Respite Care; or
  3. Attendance at an Adult Day Care Center providing Adult Day Care.

Monthly Benefit

Policy benefits pay out based on a monthly amount.


Nursing Care

Skilled or intermediate care provided by one or more of the following health care professionals: registered nurse, licensed vocational nurse, licensed practical nurse, physical therapist, occupational therapist, speech therapist, respiratory therapist, medical social worker or registered dietitian.


Nursing Home

A facility which:

  1. is licensed and operated to provide Nursing Care for a charge (including room and board), according to the laws of the jurisdiction in which it is located; and
  2. has services performed by or under the continual, direct and immediate supervision of a registered nurse, licensed practical nurse or licensed vocational nurse, on-site twenty-four (24)hours per day.

A Nursing Home may be a freestanding facility or it may be a distinct part of a facility, including a ward or a wing of a hospital or other facility.


Physician

Any person licensed as a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.) practicing within the scope of his or her license issued by the jurisdiction in which the services are rendered.


Policy Limit

The total amount of coverage, from which the insured will be paid benefits for all covered care and services.


Shared Care benefit or Shared Policy

Allows the insured’s partner to access the available benefits under the insured’s policy once the insured’s partner’s Policy Limit have been exhausted.


Simple Inflation

On each anniversary, the benefit will increase the original Long-Term Care Benefit by five percent (5%) of the original amount on each anniversary.


Terminally Ill

There is no reasonable prospect of cure and have a life expectancy, as estimated by a Physician, of 12 months or less.


Waiver of Premium Benefit

Policy premiums do not have to be made.


   
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