familiarize you with phrases commonly used in conjunction with
long term care insurance policies, the following is a list of
common terms with a link to their definitions.
of Daily Living (ADLs)
Plan of Care Benefit
Care Retirement Community
Supplement ("Medigap") Insurance
Privileged Care Coordinator
of Daily Living (ADLs):
Everyday functions and activities individuals usually do without
help. ADL functions include bathing, continence, dressing, eating,
toileting, and transferring. Many policies use the inability
to do a certain number of ADLs (such as 2 out of 6) to decide
when to pay benefits.
Care for illness or injury that develops rapidly, has pronounced
symptoms, and is finite in length. An example is medical care
for a short time to cure a certain illness and/or condition.
Adult Day Care:
Social, recreational and/or rehabilitative care services provided
for someone who can benefit from daytime supervision. This is
an alternative between care in the home and in an institution.
It refers to health support and rehabilitation services provided
in the community to people who are unable to care for themselves
independently during the day but are able to live at home at
Adult Foster Care: A live-in arrangement where one adult
lives with and is cared for by an unrelated individual or family.
This arrangement may be certified by the state or managed independently.
Alternate Care Facility: A licensed residence other than a
skilled nursing facility where care services are delivered (e.g.,
hospice, assisted care or Alzheimer's facilities).
Alternate Plan of Care Benefit: Payment for a special arrangement
or services to allow the insured to receive benefits for services
outside the coverages of a long term care policy (e.g., in-home
safety devices, home delivered meals, stays in special types
of facilities, additional equipment benefits).
Alzheimer's Disease: A progressive, degenerative form of
dementia that causes severe intellectual deterioration.
Alzheimer's Units: Special living units within skilled
nursing facilities or assisted living facilities specifically
providing care and services for those with Alzheimer's disease.
Loss of the ability to use or understand language.
A determination of physical and/or mental status by a health
professional based on established medical guidelines.
Care Facility (ACF):
A non-medical facility that provides room, board, laundry, some
forms of personal care, and usually recreational services. Often
licensed by state departments of social services, these facilities
exist under several names including domiciliary care facility,
sheltered house, board and care home, community-based care facility,
and residential care facility.
Bed Reservation Benefit: Pays for reserving your bed in a care
facility should you need to leave for a certain period of time
during a covered stay.
The length of time that a policy will pay the daily benefit (usually
calculated by multiplying the daily benefit amount times the
days of covered care).
A health care professional whose training includes managing and
arranging for long term care services. This person can be a doctor,
nurse, social worker or other similarly trained and licensed
Services typically provided by a nurse or social worker, to assess,
coordinate and monitor the overall medical, personal, and social
services needed by an individual requiring long term care.
Caregiver, Primary: The key person (usually a relative)
overseeing and/or providing care for a person who is incapacitated.
Caregiver(s), Secondary: Relatives or others who assist part-time
in giving care.
Catastrophic Illness: An illness that causes sudden temporary
or permanent change or significant disruption to a person's normal
Care for an illness continuing over a protracted period of time
or recurring frequently.
Cognitive Impairment: A deficiency in a persons short
or long term memory; orientation as to person, place and time;
deductive or abstract reasoning; or judgement as it relates to
Continuing Care Retirement Community
(CCRC): A residential
community providing a variety of living arrangements and services,
which may range from independent living apartments to assisted
care facility (ACF) and skilled nursing facility (SNF) care.
A discount applicable if both partners are eligible and apply
Services that can be given safely and reasonably by a trained
or capable non-medical person, designed mainly to assist with
ADLs, such as bathing, eating, dressing, and other routine activities.
The amount of insurance benefit in dollars per day a person chooses
for long term care expenses (typically between $50 and $250-selected
by the applicant).
Deterioration of mental faculties due to a disorder of the brain.
Elimination Period: A type of deductible; the length of
time the insured must pay for long term care services before
the insurance policy begins to make payments. The longer the
elimination period in a policy, the lower the premium.
Home Health Care:
At home services for occupational, physical, respiratory, speech
therapy, or nursing care. Also included are medical, social worker,
home health aide, and homemaker services.
Home Modification: Physical adaptations to a home that
enable a person to stay and function in that environment.
Homemaker Services: Services designed to provide household
support. They may include light housekeeping, laundry, shopping,
cooking, home management and similar services.
Hospice Care: Is
usually provided at home and provides care to alleviate physical,
emotional, or spiritual discomforts near the end of life.
Inflation Protection: An optional policy feature that provides
for increases in benefit levels over time to help pay for expected
inflation in the costs of long term care services.
Intermediate Nursing Care: Assistance needed for stable conditions
that require daily, but not 24-hour, nursing supervision. This
care is initially ordered by a physician and supervised by registered
nurses. It is less specialized than skilled nursing care, often
involves more personal care, and is generally needed for a longer
period of time.
Lapse: Termination of a policy when a renewal
premium is not paid.
Measures of income and assets to determine eligibility for government
benefit programs such as Medicaid.
A means-tested medical and health welfare program supported by
federal, state and local funds, and administered by each state
to provide health care for eligible poverty level individuals.
The federal program providing hospital and medical insurance
to people aged 65 or older and to certain younger ill or disabled
persons. Benefits for nursing home and home health care services
Medicare Supplement ("Medigap")
Insurance: A private
insurance policy that supplements Medicare benefits by covering
co-payments and deductibles for medical and hospital expenses.
These policies do not provide coverage for personal or custodial
Nonforfeiture Benefit: An optional benefit that provides
you with a reduced, paid up personal benefit account.
A licensed facility that provides room and board and a planned,
continuous medical treatment program, including 24-hour-per-day
skilled nursing care, personal care, and custodial care.
Assistance provided by another person to help with walking, bathing,
eating and other routine daily tasks.
Plan of Care: A
written, individualized plan prescribed by a physician or developed
by other qualified health care professionals that specifies the
type and frequency of all services required by the recipient
of the care.
Pre-existing Condition: An illness or disability for which
you were treated or advised within a time period before applying
for the policy.
Preferred Health Discount: A discount received on policy premiums
available to applicants who are determined to be in good health.
Privileged Care® Coordinator: A trained health care professional,
a local expert in long term care services or a facilitator who
will help insure your safety and comfort, in the setting that's
right for you, including your home.
Respite Care: Long
term care services provided at home or in a facility to temporarily
relieve the family or friends who normally provide care for an
Skilled Nursing Care: Nursing and rehabilitative care that
is performed by skilled medical personnel, usually available
24-hours-a-day and ordered by a physician under a treatment plan.
It can be either in a facility setting or at home. (Note: Medicare
and Medicaid both have their own definitions of "skilled
nursing care" which do not necessarily match those in long
term care insurance policies.)
Nursing Facility (SNF):
A state-licensed institutional setting that provides skilled
care by skilled medical personnel. This care is available 24-hours-a-day
and is ordered by a physician under a treatment plan.
The process whereby an individual uses up most of his or her
income and assets to meet Medicaid eligibility requirements.
Survivorship Benefit Option: A benefit that waives premiums due
on a surviving partner's policy after both partners have had
policies in force for a certain period of time and other criteria
Third-party Notification: A process that lets you name someone
who the insurance company would notify if your coverage is about
to lapse due to a failure to pay premium. The notice can go to
a relative, friend, or professional such as a lawyer or accountant,
Unintentional Lapse Protection: A policy provision to reinstate coverage
that has lapsed (providing that back premiums are paid) when
the lapse is due to cognitive impairment or loss of functional
Waiver of Premium: A provision in an insurance policy
that relieves the insured from having to pay premiums while receiving