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Key Takeaways
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Educational Objective
V.A.1. Regarding long-term care insurance, be able to identify: a. Why this coverage might be needed; b. Standard levels of care; c. Places services are generally provided; d. The triggers for policy benefits (activities of daily living — ADLs, cognitive impairment, or Alzheimer's disease); e. Marketing standards and responsibilities including Health Insurance Counseling and Advocacy Program (HICAP); f. Available forms of LTC coverage; g. Guaranteed renewability and rates.
Long-term care (LTC) insurance includes any insurance policy, certificate, or rider that provides coverage for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services that are provided in a setting other than an acute care unit of a hospital.
Long-term care insurance includes all products containing any of the following benefit types:
Institutional care including care in a nursing home;
Convalescent facility;
Extended care facility;
Custodial care facility;
Skilled nursing facility;
Personal care home;
Home care coverage including home health care;
Personal care;
Homemaker services;
Hospice or respite care; or
Community-based coverage including adult day care, hospice, or respite care.
Long-term care insurance includes disability-based LTC policies, but does not include insurance designed primarily to provide Medicare supplement or major medical expense coverage.
In California, long-term care insurance contracts may be designed to pay for care only in one of the following settings:
In a facility;
In a person's home (or the home of another); or
In any "community-based" setting, such as adult day care or hospice care.
Long-term care contracts can also be designed to be "comprehensive" — paying for care in either a facility setting or in home-based or community-based care settings.
Although long-term care insurance could be added by rider to either a Medicare supplement or health insurance policy, it does not pay for any Medicare or other major medical expenses.