Long term care elimination period is one of the most important aspects of an LTC plan that interested buyers and existing policy holders should know and understand. Each policy contains specific provisions that regulate one's eligibility for benefits. Let us look at what elimination period is, what are its options, and how to choose among them.
Elimination period in LTC is also known as the waiting period or the policy deductible. It is called waiting period since it is the time that the policy holder must wait from the time the claim is made until the policy actually pays out benefits. During this time, the plan holder must pay all costs from his own bank savings or financial resources. Similarly, it is also referred to as policy deductible which is quite the same with the deductible in major health insurances. The difference is that in this waiting period, there is a specified number of days for you will pay for your own care until you become eligible for coverage.
One should also note that this period is also the number of days after the original coverage effective date of the policy. No need for the days to be consecutive. During this, the policy holder should be chronically ill and have been receiving primary care services aside from hospice or respite care before his benefits become payable.
Each insurance companies and each type of policies have different conditions regarding long term care elimination period. Aside from this, some modifications can also exist depending on the rules of the state where the policy holder lives. Upon receiving the LTC plan purchased, one can look at the schedule of benefits page wherein the important details regarding the policy deductible are stated. It is highly advised that an interested policy buyer and of course, the existing plan holder must make sure that the waiting period must coincide with the specifics of his LTC insurance policy. This period should only be satisfied once. It is also not needed to obtain benefits for respite care, hospice care, needs assessment and informal caregiver services.
Plan holders have the choice between 0, 30, 60, 90, 180, or 365 days for their waiting period. Premiums are usually more costly for short periods. However it is important to know that not all insurance carriers or companies offer all these options, others only offer a few. Upon the purchase of the LTC policy, one can also decide on the period and most of the times, this cannot be changed anymore once the policy is activated.
Calendar Day VS Service Day Elimination Period
There are two types of long term care elimination period, calendar day and service day. In the first type, period starts when the insured qualifies for eligibility for LTC benefits. Once this happens, the succeeding days will count towards the completion of the required period. On the other hand, in service day, upon the insured's qualification for eligibility to receive benefits, it is compulsory to receive actual long term care services which must be equivalent to the number of days in the elimination period before benefits can actually be received.
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