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F. Ways to Issue Contracts

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Key Takeaways
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Educational Objective
  • V.A.1.f. Be able to identify LTC coverage methods: i. LTC Insurance definition: 1) Tax qualified; 2) Non-tax qualified; 3) California Partnership for Long-Term Care (CCR 58056); ii. Endorsement/rider to life or annuity policies; iii. Range of daily and policy limits; iv. Suitability standards (CIC10234.95(c)).
  • V.A.1.g. Be able to identify guaranteed renewability and rates.

1. Individual and Group

Long-term care insurance policies may be purchased on an individual basis, much like other individual health insurance policies. An individual policy provides benefits to a single individual and is issued based upon individual underwriting considerations.

Long-term care insurance may be purchased on a group basis, either at an insured's place of employment or as a member of an association. Group LTC policies must provide the insured, who would otherwise lose their coverage, with the right to continue or convert the LTC coverage into an individual policy without proof of insurability.

2. Tax qualified and Nonqualified

A long-term care insurance policy meets the definition of a qualified long-term care insurance contract if all of the following are present:

  • The only insurance protection provided under the contract is coverage of qualified long-term care services;
  • The contract does not pay or reimburse expenses incurred for services that are reimbursable under Title XVIII of the Social Security Act;
  • The contract is guaranteed renewable;
  • All premium refunds and dividends are used to reduce future premiums or increase future benefits to offset inflation; and
  • The contract satisfies certain consumer protection provisions concerning model regulation and model act provisions, disclosure, and nonforfeitability.

Only products that meet the Qualified LTC definitions are eligible to be marketed as Partnership LTC plans.

TopicQualifiedNonqualified
PremiumsCan be included with other annual uncompensated medical expenses for deductions from incomeMay or may not be deductible by the insured
BenefitsGenerally will not be counted as income.May or may not count as income.
Benefit triggerFederal law requires an insured be unable to perform 2 ADLs without substantial assistanceBenefit triggers are not restricted to 2 ADLs
Medical necessityCannot be used as a trigger for benefitsCan be offered as benefit triggers
Chronic illness or disabilityMust be expected to last for at least 90 daysNo requirement for 90-day period
Cognitive impairmentA person must require substantial supervision to trigger coverageNo restrictions on coverage

Qualified vs. Nonqualified LTC Plans

3. Endorsement to Life Policy

An alternative to purchasing an LTC insurance policy is an agreement by a life insurance company, known as living benefits, to advance a life insurance policy benefits rider. Living benefit riders agree to pay a part of the policy death benefit to insureds in order to pay for long term care or nursing home care, should the need arise. The rider will generally stipulate the conditions under which the benefit is triggered (attaining age 65 to 85, etc.). The advance is treated as a lien against death benefit of the policy.