Glossary of Long-Term Care Insurance Terms

Activities of Daily Living (ADLs)

Activities that are a normal part of everyday life, such as bathing, continence, dressing, eating, toileting, and transferring.

Adult Day Care

Care given in a nonresidential, community-based group program designed to meet the needs of functionally impaired adults. It is a structured, comprehensive program that may provide a variety of health, social, and related support services during any part of a day.

Alternative Plan of Care

If you otherwise qualify for benefits, this provision allows you to qualify for benefits not specifically listed in the policy upon the agreement of you, your physician, and the company.

Annuitant

A person who receives benefit payments from an annuity.

Annuity

An insurance contract where an insurance company promises to make payments to an annuitant over a specified period of time or for life.

Assisted Living Facility

A facility certified or registered by the Department of Health and Family Services (DHFS). These facilities exist to bridge the gap between independent living and nursing homes and provide a variety of services depending on the needs of the residents.

Bed Reservation

This benefit is payable if you are receiving nursing home care and need to spend time in a hospital. The company will cover any charge made by the nursing home for reserving your bed during your hospitalization.

Benefit Triggers

A term used to describe when to pay benefits. One type of benefit trigger is an activity of daily living (ADL). Insurance companies may use different events or types of benefit triggers to determine when benefits will begin to be paid. The triggers are described in the eligibility criteria of the policy.

Care Coordination

Services provided by a licensed or certified health care professional designated by the insurance company to perform an assessment and develop a plan to meet your long-term care needs.

Caregiver Training

Training provided in order to assist an informal and unpaid caregiver to care for you at home.

Case Management

Services provided by a licensed or certified health care professional to assist in arranging, monitoring, or coordinating long-term care services.

Cognitive Impairment

A deficiency in your short-term or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.

Community Based Residential Facility (CBRF)

These facilities are licensed, registered, or certified by the Department of Health and Family Services (DHFS). CBRFs are covered only if your policy identifies these facilities as a covered benefit and the facility has been licensed as a CBRF by DHFS.

Contingent Nonforfeiture or Contingent Benefit Upon Lapse

If you reject the mandatory offer of a nonforfeiture benefit, the insurance company must provide a "contingent benefit upon lapse." This means that when the premiums increase to a certain level (based on a table of increase provided to you in the policy information), the benefit will take effect. You will then be offered, within 120 days of the due date of the new premium, the opportunity to accept one of the following options: 1) reduce your benefits provided by the current policy so that your premium will stay the same, or 2) convert your policy to a paid-up status with a shorter benefit period.

Elimination Period

The number of days you must wait after receiving long-term care before receiving insurance benefits.

Exclusion

Any condition or expense that the policy will not pay.

Guaranteed Purchase

A rider to a policy that allows you to increase the benefits during specific periods of time without proof of insurability.

Home Health Care

Care including skilled nursing services, such as providing therapy treatments or administering medication; home health aide services, such as checking temperature and blood pressure; personal care such as help with bathing, dressing, walking, exercise; and physical, occupational, respiratory, or speech therapy.

Hospice Care

A specially designed package of social and medical services that primarily provides pain relief, symptom management, and supportive services to terminally ill people and their families.

Instrumental Activities of Daily Living

Basic functional activities necessary for you to remain in your home, such as meal preparation, shopping, light housekeeping, laundry, telephoning, and handling money and paying bills.

Licensed Health Care Practitioner

Any physician, registered nurse, licensed or certified social worker, or any other individual who meets such requirements as may be prescribed by the Secretary of the Treasury.

Outline of Coverage

A summary of a policy's benefits and limitations that makes it easier to understand a policy and compare it to others. Insurance companies must provide you with this summary before you purchase a long-term care policy.

Paid-up Survivor

A rider that, in the event of the death of your spouse, waives the premiums for life if both you and your spouse had coverage for a specified time with the same company.

Plan of Care

A plan outlining the care you need and the length of time the care will be needed.

Residential Care Apartment Complexes (RCAC)

These facilities are certified by the Department of Health and Family Services (DHFS). RCACs are covered only if your policy identifies these facilities as a covered benefit and the facility has been certified as a RCAC by DHFS.

Respite Care

The provision of personal care, supervision, or other services to a functionally impaired person to relieve a family member or other primary caregiver from caregiving duties. Respite care services are usually provided in the impaired person's home or in another home or homelike setting, but may also be provided in a nursing home.

Restoration of Benefits

If you collect benefits from a policy and then recover to the point where you are not receiving care qualifying you for benefits for a certain period of time, you can have those benefits restored back to the original level. Look to see if this is a provision in the policy or if it is available as a rider for an additional premium.

Return of Premium

A rider that provides that if you die after being insured for a specified period or if you have paid premiums for a specified period, the insurance company will return premiums paid minus any benefits paid.

Waiver of Premium

The suspension of premium payments after you have been receiving benefits from the policy for the period of time specified in the policy.