Glossary

Activities of Daily Living —Personal care activities that may include bathing, dressing, eating, transferring, toileting, continence, and mobility.

Assisted Living Facility — A residential facility that provides room, board, and 24-hour personal care to individuals with long-term care needs. It is a care option for individuals who are not able to manage at home, but do not need the level of skilled care provided in a nursing home. It may also be called a Custodial Care facility.

Bed Hold Benefit — If your stay in a Nursing Home or Assisted Living Facility is interrupted because you are hospitalized, we will continue to pay benefits to assure a place will be available when you return to the same facility. The duration of benefits available varies; please check your policy coverage for the specific number of days available.

Benefit Amount (Daily/Monthly) — Your Benefit Amount represents the maximum amount of money per day or per month*, as chosen by you, that your policy will provide to cover your long-term care needs.

* The maximum amount paid per day is the Daily Benefit amount. The maximum amount paid per month is the Monthly Benefit amount.

Benefit Period — The minimum period of time (years) you can expect your coverage to last.

Coordination of Benefits — In some instances benefits that are available under your Long-Term Care policy may coordinate with other insurance or government programs such as Medicare and Medicaid. Policies do not cover services, including co-insurance or deductibles when Medicare is covering your long-term care. In some instances your policy may be able to cover services in addition to those paid for by Medicare, for example if you are receiving skilled home health care covered by Medicare you may also be eligible to receive custodial home health care that Medicare is not covering.

Covered Charges — Charges incurred that are covered by your long-term care policy. Typically covered charges include such things as Home Health Care both skilled and custodial, room and board in an Assisted Living Facility or Skilled Nursing Facility.

Custodial care — Non-skilled long-term care services aimed at maintaining your health and/or preventing deterioration in your functional status.
Daily Benefit — The maximum amount your long-term care insurance will pay in any single day.

Date of Service — A day that you are eligible for benefits under your policy, including Dates of Service during the Elimination period.

Elimination Period (Qualification Period) — The Elimination Period on your long-term care insurance policy is like a deductible. Before your LTC policy will begin paying benefits, you must first pay for your own long-term care costs for a certain number of days. In some policies, the Elimination Period is dates of service, and in others, it is calendar days. Please refer to your policy’s definition.

Home Health Aide — non-medical professional who provides custodial care in your home

Home Health Care — Medical and non-medical professional or personal care services provided in your home. Home Health Care may include occupational, physical, respiratory, or speech therapy, as well as custodial and/or nursing care.

Homemaker services — The non-medical and incidental support services that are necessary for you to be able to remain in your own home: meal preparation; laundry; light housekeeping; and supervising self-administration of medicine.

Hospice care — Care intended to alleviate physical, emotional, or spiritual discomforts near the end of life.

Licensed health care practitioner — A physician, a registered nurse (R.N.), a licensed certified social worker (LCSW), or any other individual who meets the requirements as may be prescribed by the Secretary of the Treasury.

Lifetime Maximum Benefit — The total pool of money payable for covered long-term care services received while insured

Long-Term Care — Personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. Long-Term Care can be provided at home, in a nursing home, assisted living facility, or an adult day care center.

Long-term Care (LTC) insurance — Insurance that helps defray the costs of assistance with the activities of daily living or the costs of supervision due to a severe cognitive impairment.

MDS — the Minimum Data Set is a federally-mandated process for clinical assessment of all residents in Medicare/Medicaid-certified nursing homes. This assessment contains information in a variety of categories including, but not limited to: cognitive patterns, physical functioning, disease diagnoses, and treatments/procedures.

Monthly benefit — The maximum amount your long-term care insurance will pay in any single month.

Non-duplication of benefits — Your policy will only pay covered charges in excess of the charges covered under Medicare (including amounts not reimbursable by Medicare such as a Medicare deductible or coinsurance amounts) (this means that your policy will not pay for your Medicare deductibles or coinsurance), other government programs (excluding Medicaid) or any state or federal workers’ compensation, employer’s liability or occupational disease law.

Nursing Care — Skilled or intermediate care provided by one or more of the following health care professionals: registered nurse (R.N.), licensed vocational nurse, licensed practical nurse, physical therapist, occupational therapist, speech therapist, respiratory therapist, medical social worker or registered dietician.

Nursing home — A licensed facility that provides 24-hour-per-day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy, and other health related services.

Period of Care – A Period of Care is the period of your claim and is measured from your first Date of Service and ends when there is 180 consecutive days for which you have not received covered services.

Plan of care — A plan prescribed by a licensed health care practitioner that identifies services that meet your long-term care needs

Policy limit — The total amount from which you will be paid benefits for all covered care and services. All benefits will be deducted from the policy limit.

Respite Care – Short-term care designed to provide temporary relief to your primary caregiver. Respite care may be provided in a Skilled Nursing Facility, Assisted Living Facility, Adult Day Care, or your home.

Restoration of Benefits – When you are no longer eligible for benefits for a period of 180 consecutive days or more, and if you have not exhausted available benefits, we will restore the full Policy Limit.

Skilled nursing care — Nursing care that is performed by skilled medical personnel. It can be either in a facility setting or at home. (Note: Medicare and Medicaid have their own definitions of “skilled nursing care” which do not necessarily match those in long term care insurance policies.)

Skilled nursing facility — Generally 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.

Stay at Home Benefit — Additional funds available that can be used to pay for a variety of long-term care expenses while you are living in your home that are not otherwise covered under the policy.