Margie Barrie, a veteran long-term care insurance (LTCI) agent, marketer and educator, has been writing articles about long-term care (LTC) planning and related issues for several years. Here she takes a question about elimination periods — when coverage holders who qualify for benefits can hope to start collecting benefits.
Q. I represent multiple LTCI carriers and need to explain to clients how the elimination periods work. For example, when do the calendar days start counting in the various policies?
A. Let’s start by using a scenario that we could hear from clients and their families: A policyholder has a debilitating stroke. On day 1 he goes to the hospital. On day 15 he goes to the rehab unit in the hospital. On day 30 he still needs considerable help bathing and dressing, so he is admitted to a nursing home for care.
When does the LTCI start paying benefits?
Be aware that carriers definitely differ in the method they use to count the calendar-day elimination period. It is important to show your clients how their specific policies work.
The following information was compiled by Ed Hutman, an agent in Rockville, Md., who agreed to provide it to “LTCI Insider.”
1. Genworth PC Flex 2 and Flex 3
“The elimination period is satisfied by days you are chronically ill, beginning with the first day you incur a covered expense.”
2. Life Secure
“Benefit wait period is defined as the total number of days that you remain chronically Ill before benefits are payable. The benefit wait period begins on the first day that we verify you are chronically ill.”
3. Mass Mutual
“Elimination period means the number of days the insured must receive either facility service or home and community-based services, as defined in this policy, pursuant to a plan of care, while this policy is in force and the insured is certified as being chronically ill, before we will begin paying benefits. For each day the insured receives facility services or home and community-based services, we will credit day toward satisfaction of the elimination period.”
4. Med America
“The elimination period is the number of calendar days You must wait before you receive benefits. Your elimination period begins when you are certified as being chronically ill.”
5. Mutual of Omaha Solutions
“Elimination period means the initial number of calendar days that you must be chronically ill before we will pay benefits under your policy. The elimination period begins on the first day you are chronically ill and receive a covered service.”
6. Mutual of Omaha Custom Care
“The elimination period commences on the first day you are eligible for benefits under this policy and on which you:
- are confined to a nursing home or an assisted living facility;
- receive home health care or adult day care; or
- receive long-term care services covered under this policy that are Medicare eligible (for which benefits are not payable under this policy).”
“Elimination period is defined as the number of days that you must be confined as an overnight bed patient in a long-term care facility before we will pay benefits.
The long-term care facility benefit, the long-term care facility bed reservation benefit and the alternate plan of care benefit are subject to the elimination period.
The home care and adult day care benefit is not subject to the elimination period.”
Here’s a chart giving another view of this information.