Long Term Care Insurance Glossary

Accelerated Death Benefit A feature of a life insurance policy that lets you use some of the policy's death benefit prior to death.
Activities 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 to decide when to pay benefits
Adult Day Care Care during the day for adults, usually at senior or community centers
Alzheimer's Disease
A progressive, degenerative form of dementia that causes severe intellectual deterioration
Assisted Living Facility A residential living arrangement that provides individualized personal care and health services for people who require assistance with ADLs
Benefit Triggers Term used by insurance companies to describe when to pay benefits
Care Management Services A service in which a professional, typically a nurse or social worker, may arrange, monitor, or coordinate long-term care services
Chronic Illness An illness with one or more of the following characteristics: permanency, residual disability, requires rehabilitation training, or requires a long period of supervision, observation, or care
Cognitive Impairment A deficiency in a person's short or long-term memory; orientation as to person, place and time; deductive or abstract reasoning; or judgement as it relates to safety awareness
Community-Based Services Services designed to help older people stay independent and in their own homes
Custodial Care (Personal Care) Care to help individuals meet personal needs such as bathing, dressing, and eating. Care may be provided by someone without professional training
Daily Benefit The amount of insurance benefit in dollars a person chooses to buy for long-term care expenses
Dementia Deterioration of intellectual faculties due to a disorder of the brain
Elimination Period A type of deductible; the length of time the individual must pay for covered services before the insurance company will began to make payments
Guaranteed Renewable When a policy can not be cancelled and must be renewed when it expires unless the benefits have been exhausted. The company cannot change the coverage or refuse to renew the coverage for other than nonpayment of premiums
Health Insurance Portability and Accountability Act (HIPAA) Federal health insurance legislation passed in 1996 that allows, under specified conditions, long-term insurance policies to be qualified for certain tax benefits.
Home Health Care Services for occupational, physical, respitory, speech therapy, or nursing care. Also included are medical, social worker, home health aide, and homemaker services
Homemaker Services Household services done by someone other than yourself because you are unable to do them.
Inflation Protection A policy option that provides for increases in benefit levels to help pay for expected increases in the costs of long-term care services
Lapse Termination of a policy when renewal premium is not paid
Long-term Care Insurance Coverage Policies of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital. Benefits may be provided for institutional care, such as confinement in a nursing home and community based services, such as adult day care and home health care
Medicaid A joint federal/state program that pays for health care services for those with low incomes or very high medical bills relative to income and assets.
Medicare The federal program providing hospital and medical insurance to people aged 65 or older and to certain ill or disabled persons. Benefits for nursing home and home health services are limited
Medicare Supplement Insurance A private insurance policy that covers many of the gaps in Medicare coverage
National Association of Insurance Commissioners (NAIC) Membership organization of insurance commissioners. One of it's goals is to promote uniformity of state regulation and legislation related to insurance
Noncancellable Policies Insurance contract that cannot be cancelled and the rates cannot be changed by the insurance company
Nonforefiture Benefits A policy feature that returns at least part of the premium to you if you cancel your policy or let it lapse
Pre-existing condition Illnesses or disability for which you were treated or advised within a time period before applying for a life or health insurance policy
Rescind When the insurance company voids (cancels) a policy
Respite Care Offers a few hours to several days of help to relieve family caregivers
Rider Additional to an insurance policy that changes the provisions of the policy
Spend Down A requirement that an individual use up most of his or her income and assets to meet Medicaid eligibility requirements.
State Health Insurance Assistance Program Federally funded program to train volunteers to provide counseling on the insurance needs of senior citizens
Substantial Assistance Means hands-on or standby help required to do ADLs (Activities of Daily Living)
Substantial Supervision The presence of a person directing and watching over another who has a cognitive impairment
Tax Qualified Long-Term Care Policy A policy that conforms to certain standards in federal law and offers certain federal tax advantages
Third Part Notice A benefit that lets you name someone who the insurance company would notify if your coverage is about to end due to lack of premium payment. This can be a relative, friend, or professional such as a lawyer or accountant, for example
Underwriting The process of examining, accepting, or rejecting insurance risks, and classifying those selected, in order to charge the proper premium for each
Waiver of Premium A provision in an insurance policy the relieve the insured of paying the premium while receiving the benefits
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