Terms, Acronyms & Definitions:
The Long-Term Care Glossary

Commonly used terms for residents, patients, families, and staff in long-term health care. Always review definitions that may differ in documentation for your personal care.

Glossary Terms from A to Z

A

An accelerated death benefit is when a life insurance policyholder gains access to a portion of their death benefits before death, usually to pay for long-term care or other medical needs.

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Activities of daily living (ADLs) are learned activities that each person performs to live a normal life.

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An actuarial certification is a formal recognition that a Long-Term Care Insurance company's premiums meet federal standards.

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An actuary uses data to analyze and evaluate risk. They commonly work with insurance companies, businesses, and government entities.

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Acute care involves urgent medical services, often expected to be short-term or rehabilitative.

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Adult day care centers (ADCC) provide long-term health care to individuals during the day. They can help provide mental, social, and physical stimulation and fulfillment to aging or disabled adults.

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Aging in place describes when an individual receives care in their home or community. This care aims to extend the time individuals can remain at home, delaying a transfer to a traditional long-term care facility.

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An alternative care benefit is a Long-Term Care Insurance provision that provides benefits not explicitly outlined within the original policy.

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Alzheimer's disease is a common form of dementia. This disease affects a person's thinking, remembering, and functioning ability. Most people with Alzheimer's will need long-term care support.

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In a Long-Term Care policy, it is coverage for items like physical, occupational, speech and respiratory therapies, wound care, medication management, supplies.

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An annuity is an insurance contract that acts as a savings vessel, providing stable income in old age.

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Arthritis is a term used to describe significant joint pains or diseases.

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This is a professional determination of a person’s health that is generally part of the claims process in many Long-Term Care Insurance policies.

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Generally referred to as a hybrid policy, this is an insurance policy which combines a life insurance policy or annuity with a rider for Long-Term Care.

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An assisted living facility is a residential building with long-term care support services. Assisted living facilities can be a good fit for anyone needing a minor to moderate level of care and wanting to maintain independence.

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B

Bathing is an activity of daily living, generally defined as the ability to wash oneself.

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If you are receiving benefits under a Long-Term Care policy and you need to leave a facility (assisted living facility, memory care facility, or nursing home) the policy will continue to pay to “reserve” your room or bed at the facility even though you are not there.

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This is a named person, trust, or other legal entity which you can designate in a Long-Term Care Insurance policy to receive benefits from your policy after your death.

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The benefit period is the minimum period of time policyholders can receive Long-Term Care Insurance benefits.

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A benefit trigger is a requirement that must be met before accessing Long-Term Care Insurance benefits. Once someone meets the benefit trigger requirements, they can file a claim and receive their benefits.

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C

A caregiver is an individual who cares for another individual who cannot take care of themselves, often due to aging, disability, or illness.

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Many Long-Term Care Insurance policies provide professional assistance to develop a plan of care and help family members find providers and services based on the person’s needs and preferences.

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A Cash Benefit will pay a cash benefit, paid directly to the insured, once a person qualifies for benefits. With some policies, this can be the full benefit or a reduced benefit instead of the full reimbursement benefit offered by the policy.

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A certified nursing assistant (CNA) provides mostly basic and custodial care to individuals in several care settings.

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Chronic care refers to care and services that help achieve functional independence for those with continuing and long-term health problems as opposed to "acute" care which refers to short term care of a severe illness.

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Chronic illness riders are a type of insurance add-on for life insurance policies. Many people mistake these riders for Long-Term Care Insurance. However, chronic illness riders don't offer the same coverage as Long-Term Care Insurance.

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Under the law, a “chronically ill individual” is any person who has been certified by a licensed health care practitioner as meeting one of three tests.

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In a Long-Term Care Insurance policy, this is a common contractual language that provides the insurance company to apply inflationary benefit increases to the remaining benefit pool of money within the policy instead of using the original amount.

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It is used for any possible rate increase as any approved increase by a state's Department of Insurance must be by "class". In other words, an insurance company may not increase a premium to just one person or a small group of persons, only a class of people.

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This is the concept of sharing the cost of future long-term care services and supports with an insurance company. It refers to the amount of money that the insured must pay out-of-pocket to make-up the difference between their actual costs and the amount the policy covers.

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Cognitive Impairment or cognitive loss describes when an individual starts to have problems remembering things be it a short-term or long-term memory. It also impacts a person’s ability to learn new things, the ability to concentrate or make decisions that affect an individual’s everyday life.

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These are services designed to help elderly or chronically ill individuals which help them stay at home. These include services and programs such as meals on wheels and adult day care, that are designed to help care for people with chronic conditions and their functional capability

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Companion care is when a caregiver provides emotional support and connection to an individual.

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A compound inflation rider increases Long-Term Care Insurance benefits by a set percentage each year. Because this percentage is compounded, the benefits increase based on the new total. This can help offset increasing care costs.

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A comprehensive Long-Term Care Insurance policy covers a majority of long-term health care services. These policies are regulated by federal laws and industry guidelines.

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The ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).

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The opportunity in all tax-qualified Long-Term Care policies to provide the policyholder options in the event the insurance company gets approved a rate increase of over a certain percentage as listed in the policy.

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A residential retirement community where a variety of living and medical services are provided to residents who are in need of continuous care and/or supervision.

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This is an institution devoted to providing medical, nursing, or custodial care for an individual over a prolonged period, such as during the course of a chronic disease or the rehabilitation phase after an acute illness.

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The coordination of benefits provision is some policy contracts means a Long-Term Care policy will pay benefits only after any other insurance policy or government agency has made payment.

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Countable assets are owned items or money evaluated when determining Medicaid eligibility.

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An option that is offered on several Long-Term Care Insurance policies provides the insured the ability to increase their benefits on an annual basis based upon the Consumer Price Index

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Criminalization is persons who knowingly and willfully dispose of assets in order to become eligible for Medicaid payment of Long-Term Care expenses are subject to criminal penalties if doing so results in a period of ineligibility for Medicaid benefits.

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This is the type of long-term care service most people will require. when they need long term health care services. This is nonmedical help and assistance for an individual who requires either hands-on or standby assistance with activities of daily living.

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D

The daily benefit for an LTC Insurance policy is the maximum amount of benefits the policy will pay for long-term care services on any given day of an active claim.

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A death benefit is a large amount of money paid to one's loved ones or beneficiaries after the insured individual passes away.

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A deductible is an amount of money you’re required to pay out-of-pocket before your insurance policy will start covering the cost of care.

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This is a law signed into law by President Bush in 2005 that significantly tightens the eligibility for Medicaid payment of long-term care services. The law changed the look-back period for asset transfers from 3 years to 5 years.

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Dementia is a general term which is used to describe a person’s decline in mental ability severe enough to interfere with their daily life. Alzheimer's is the most common type of dementia.

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Dressing is an activity of daily living that refers to one’s ability to select and put on clothing.

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This is the type of equipment that is primarily being used for a medical purpose as opposed to comfort and convenience. This type of equipment is designed for repeated use. This can include walkers, hospital beds, crutches, wheelchairs, ramps and prosthetics used for in-home care.

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E

Eating is an activity of daily living that refers to the ability to consume food and beverages.

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An elimination period is a time between qualifying for Long-Term Care Insurance benefits and receiving them. These are also referred to as waiting periods.

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Emotional support is an empathetic and compassionate type of care that focuses on creating connections and improving emotional well-being.

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Estate recovery is when the government takes part of an individual's estate after they pass away to reimburse itself for the cost of Medicaid long-term care.

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These usually include care which is required as a result of an act of war, care required as a result of an intentionally self-inflicted injury, and care required as a result of alcoholism or drug addiction

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Exempt assets are those that Medicaid does not consider when determining your eligibility for Medicaid long-term care benefits.

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F

A Long-Term Care policy where benefits are only paid if the policyholder is receiving care in a licensed facility, e.g. a Nursing Home or Assisted Living Facility.

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A financial advisor is a licensed professional that offers help with financial decisions.

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This is the period of time where a person who has been approved for a Long-Term Care policy has to review their policy without cost or obligation. Most states allow you to "refuse" a policy usually within 30 days of delivery of the policy.

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A form of inflation protection in a Long-Term Care Insurance policy where the insured has the right to increase benefits periodically (e.g., every 3 years) to reflect increases in the cost of care.

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G

Geriatric refers to a field of medical care primarily focused on elderly individuals.

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A guaranteed renewable policy cannot be canceled by an insurance company without justifiable cause. All Long-Term Care Insurance policies that meet federal guidelines are guaranteed renewable.

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H

This refers to the physical assistance of another person, without which the person would be unable to perform an activity of daily living (ADL).

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The Act, in part, specifies requirements that a Long-Term Care Insurance policy must meet in order that premiums paid may be deducted as medical expenses, and benefits paid not to be considered taxable income.

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Health savings accounts (HSAs) are tax-free savings accounts that can help pay for qualified medical expenses.

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A high-deductible health plan (HDHP) is a type of health insurance with a high out-of-pocket deductible, usually with a low monthly premium.

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A home health agency provides in-home care services to those in need.

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Home health aides help individuals with their long-term care and personal care needs. These professionals are also known as personal care aides.

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Home health care is custodial or skilled care that takes place in the care recipient’s home instead of a traditional long-term care facility.

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This provides additional services in a Long-Term Care policy for a person to provide laundry, housekeeping, transportation, and shopping assistance when provided in conjunction with other home care services.

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Hospice is short-term, supportive care for the terminally ill which focuses on pain management, emotional, physical, and spiritual support for the patient and family. It can be provided at home, in a hospital, nursing home, or a hospice facility.

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If the long-term care benefit is not used or is only partially used, the unused death benefit is paid out to policyholder’s heirs like any other life insurance policy or annuity would do.

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I

This is the inability for a person to maintain control of their bowel or bladder. This could be from a partial loss of control to complete loss control.

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This is a fixed amount of money paid to a policyholder when care is received, regardless of the cost of care. A policy with a $100 a day Indemnity Benefit will pay $100 a day for each day you qualify for care regardless of the expense incurred.

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Usually, the policyholder can choose between Simple and Compound increases. Simple increases add the same dollar amount to the monthly or daily benefit each year.

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This is care provided by family or friends. Some Long-Term Care policies provide benefits for Informal care. Whether benefits are available may depend on the relationship of the caregiver to the insured, and on whether the caregiver lives with the insured.

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Inpatient care is when an individual needs intense overnight treatment for a serious or life-threatening health condition.

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Skills necessary to live independently but not necessary for fundamental functioning. IADLs, for instance, would include shopping, preparing meals, taking medications, paying bills etc.

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Integrated care combines many types of care and services to create a comprehensive care plan. This care plan should address all of a long-term care recipient’s needs.

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This is care for stable conditions requiring daily but not 24-hour nursing supervision. This type of care is often following a hospital stay or surgery and reduces the time spent in a hospital.

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This is a health facility that provides medically related services to persons with a variety of physical or emotional conditions requiring institutional facilities but without the degree of care provided by a hospital or skilled nursing facility.

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This is a provision is some Long-Term Care Insurance contracts which allows for the insured to receive benefits outside the United States and U.S. territories.

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L

This is the termination of a Long-Term Care Insurance policy due to the policyholder's failure to pay the required premium. Many policies have protections against unintentional lapses

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Policyholder's on some Long-Term Care Insurance policies can pay past-due premiums and reinstate their policies in a specified period of time after they have lapsed the policy. If the failure to pay was the result of cognitive or functional impairment additional protections are provided.

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A letter of decline is a formal notification of an insurance company's decision not to insure the applicant.

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A licensed practical nurse (LPN) provides various levels of care in many settings. They also act as the link between patients, families, and the health team to ensure comprehensive, quality care.

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Sometimes referred to as “Maximum Lifetime Benefit” it is the set limit on the amount of benefits that a Long-Term Care policy will pay. These limits are set in terms of either years or dollars, but not both.

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The same as “Lifetime Limits”. This is the maximum amount of benefits which a Long-Term Care Insurance policy will pay over the life of a policy. Generally, this is a dollar amount which can grow with inflation. Some policies use a "dates of service" or "period of time" to determine the maximum benefit.

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A premium payment option some Long-Term Care policies offer in which the person pays premiums for a set time period. The options are generally 10 years, 15 years, 20 years, or to age 65.

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Long-Term Care Insurance specialists are expert Long-Term Care Insurance professionals. Specialists often help people find the best LTC Insurance coverage for their needs.

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Long-term care addresses the medical and non-medical needs of individuals with chronic illnesses, disabilities, or dementia who cannot care for themselves. Long-term care is legally defined as care expected to last at least 90 days.

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In order to qualify for Long-Term Care benefits under Medicaid in the past, many people tried to "give away" money to children or transfer assets to a "safe" financial vehicle.

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M

Medicaid is a government-funded medical aid program. Medicaid aims to help low-income individuals pay for medical and long-term care.

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Reasonable and appropriate diagnosis, treatment, and follow-up care (including supplies, appliances, and devices) as determined and prescribed by qualified appropriate health care providers.

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Medicare is health insurance primarily for people 65 or older, those with certain health issues, or those who qualify for disability. This federal tax-supported program becomes an individual’s primary health insurance at age 65.

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Medigap or Medicare Supplement are private insurance policies which will pay for medical services that are approved but not paid by Medicare.

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Refers to a mental or emotional disease or disorder of any kind that does not have an organic origin. Both Alzheimer's and senile dementia are considered organic in origin.

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Otherwise known as the Community Spouse Resource Allowance, or "CSRA," is the amount of countable assets a spouse is allowed to hold without disqualifying an individual from Medicaid.

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N

This is a rider on a Long-Term Care Insurance policy that says if you stop paying the premium on a policy (lapse), it will provide a residual benefit to the policyholder.

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This is a facility which provides skilled, intermediate or custodial nursing care which must be state- licensed.

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A nursing home is an intensive long-term care facility that provides support and supervision 24/7.

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O

Outpatient care involves skilled care that does not require the patient to remain overnight.

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P

Palliative care is assistance that addresses both emotional and physical needs.

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The Long-Term Care Partnership program originated in the 1980s and at that time was implemented in four states: New York, California, Connecticut and Indiana. The partners were the insurance companies and the states and the state Medicaid departments.

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This is non-medical care and assistance needed to help a person perform activities of daily living and/or supervision and assistance for someone suffering from a severe cognitive impairment.

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A documented, individualized plan of long-term care services prepared by a Licensed Health Care Practitioner (LHCP). Typically a Plan of Care would include the types and frequency of care needed.

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A pool of money is the total amount of benefits available within a Long-Term Care Insurance policy. This amount can change with inflation benefits.

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Post-claim underwriting occurs when an insurance company reevaluates a policy after a claim. They may raise the premium, change benefits, or cancel the policy altogether. Post-claim underwriting is illegal for federally qualified Long-Term Care Insurance policies.

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A pre-existing condition is a health condition that an individual had before they applied for Long-Term Care Insurance.

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This is the amount of money that a policyholder pays to an insurance company in order to keep an insurance policy in force.

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A private nurse is a care professional that individuals can hire directly to provide personalized care.

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Q

A quote is a cost estimate for an insurance policy provided by the company.

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R

A rate class is a category assigned to insurance applicants based on how risky they are to insure. These categories determine how much individuals pay for Long-Term Care Insurance coverage. There are three main rate classes: preferred, standard, and sub-standard.

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Rate increases on existing Long-Term Care Insurance policies may be sought by an insurance company only if they prove a substantial need based on actuarial reasons and impacting a "class" of individuals.

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Developed by the National Association of Insurance Commissioners (NAIC), these are rules put in place to make it more difficult for insurance companies to raise premiums on Long-Term Care Insurance.

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A registered nurse (RN) maintains a leadership role, often coordinating, providing, and overseeing care services and patients within their jurisdiction.

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A rehabilitation center is a place for individuals to receive skilled and custodial care directly after an injury, illness, or surgery. The goal of rehabilitative care is to help the individual return to a previous state of good health following a medical event.

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Reimbursement is the standard way that a Long-Term Care Insurance policy will pay the policyholder (or provider) at the time of claim.

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In a Long-Term Care policy Respite Care is a paid caregiver provided to the policyholder in order to give relief to an informal caregiver in order to give them a break or relief. Most Long-Term Care policies pay for Respite Care, usually limited by a certain number of days in a year

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This is a rider on a Long-Term Care Insurance policy that allows for a partially used benefit to be fully restored if a person recovers and no longer requires care for a specified period of time, typically 180 days.

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This is an option on some Long-Term Care Insurance policies which will allow for the return of some or all paid premium following your death. The amount returned is often based on the total amount of premium you have paid in; minus any claims the policyholder paid into the policy.

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A reverse mortgage allows homeowners to convert part of their home equity to cash to pay for long-term care expenses.

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An insurance rider, often simplified to “rider,” is an extra benefit provision available to add to Long-Term Care Insurance policies. Riders usually increase the cost of the premium by adding benefits or other features.

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S

The sandwich generation describes individuals who care for their elderly parents while trying to raise their own children. These individuals often find themselves sandwiched between caring for two generations.

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Section 7702(b) is an integral Long-Term Care Insurance regulation that offers consumers protections and defines how and when policies should cover long-term care.

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Loss or deterioration in mental capacity that is comparable to Alzheimer's Disease and similar forms of irreversible dementia.

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This is a rider which can be included in a Long-Term Care policy which has become very popular for couples. Shared Care allows unused benefits to be used by a spouse or partner. This option is available when spouses or domestic partners both buy policies with identical benefits.

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Short-term care insurance covers custodial care for short durations, usually up to one or two years.

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A rider on a Long-Term Care policy where the benefit increases by a fixed amount per year based on the original starting amount. For example, with 5% simple inflation, $100 a day would increase each year by $5.00.

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Skilled care is medical care or assistance provided by a registered nurse or professional therapist. Skilled care is usually provided within a licensed facility, such as a nursing home.

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A skilled nursing facility offers skilled care for those with complex care needs who may not be able to get the help they need at other care facilities.

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This is a process of spending an individual’s savings on long-term care services and supports until their assets are depleted enough to qualify for Medicaid, the medical welfare program.

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Stability is how a condition affects an individual and how receptive that condition is to treatment and medications. A stable condition is one that can be well-managed with treatment.

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Standby assistance is care that requires a caregiver to remain close to the individual in case they need help with daily tasks.

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A policyholder can reduce the monthly or daily benefit, or the total pool of money the policy will pay or increase the elimination period.

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Tax-qualified Long-Term Care policies require a policyholder to need "substantial assistance" in performing at least two activities of daily living in order to receive benefits. "Substantial Assistance" is defined as either "hands-on assistance" or "standby assistance".

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This is the continual supervision (such as cuing by verbal prompting, gestures, or other demonstrations) that is required in order to protect the cognitively impaired individual from threats to his or her health or safety.

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This is a rider which can be purchased by a couple. If both spouses who own a Long-Term Care policy upon the death of one spouse, convert the policy of the surviving spouse to paid-up status. That is, the surviving spouse needs to pay no further premiums. This usually requires a higher premium for this option.

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T

Buyers of Tax-Qualified (TQ) plans can deduct the premiums if they itemize deductions on their federal tax return based on their Adjusted Gross Income itemization requirement.

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Therapeutic devices are medical tools and equipment that make it easier for individuals to live with their health conditions.

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One of the Activities of Daily Living used to trigger benefits under a Long-Term Care policy. This is generally defined as getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene activities.

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One of the Activities of Daily Living used to trigger benefits in a Long-Term Care policy. Transferring is the activity of getting into and out of bed or a chair or wheelchair. (See also Activities of Daily Living.)

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U

Underwriting is a process insurance companies use to calculate the risk of insuring new individuals.

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W

A provision that a policyholder of a Long-Term Care Insurance policy will not have to pay the premiums after receiving benefits from a policy.

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