Additional Services: Needs Assessment Benefits, Informal Caregiver Training Benefits
The provisions in the sample long term care insurance policy clearly state the specific
conditions under which benefits will be paid. Most policies contain provisions similar to those
outlined below.
______________
Additional Services may be received on the same day as Primary Services without
affecting the Primary Services benefit amounts. The Maximum Benefit Amounts We will pay
for Additional Services are shown on the Schedule of Benefits page.
COMMENT: The term Primary Services is not
actually defined in the Policy, but the covered Primary Services are listed on the Schedule of Benefits page. They include Nursing Home Care, Hospice Facility Care, Assisted Living Facility Care, Respite
Care, and Home Care and Community Care. Separate Maximum Benefit Amounts are shown on that
page for each of the Additional Services. As the policy states, availing yourself of
Additional Services on the same day you make use of Primary Services does not have
any impact on the benefit amount for the Primary Services. In fact, they are measured
differently. |
Two kinds of Additional Services are available for coverage under the Policy: Needs
Assessment Benefits and Informal Caregiver Training Benefits. These are discussed
below.
Needs Assessment Benefits
The provisions in the sample long term care insurance policy clearly state the specific
conditions under which benefits will be paid. Most policies contain provisions similar to those
outlined below.
After You become eligible for Benefits, You can receive, at no extra charge, one
Needs Assessment from a Care Management Organization, selected by Us and to whom We
make direct payment. Or, You may select a Care Management Organization to conduct one
Needs Assessment and We will pay as a Covered Service the actual charges You incur
up to the Maximum Benefit Amount for Needs Assessment shown on the Schedule of
Benefits page.
You do not need to satisfy the Elimination Period for this Benefit to be
payable. Receipt of this service will not count toward satisfying the Elimination Period.
Payment of this Benefit will not reduce Your Total Lifetime Benefit.
COMMENT: Needs Assessment is defined in
the policy as the services provided by a Care Advisor to: (1) assess your needs for long
term care services; (2) develop or work with others to develop options for your long term care;
and (3) discuss the long term care options with you or your Representative.
A Care Management Organization is an organization, usually but not always
licensed, that has a full time administrator, maintains written records, has at least one full
time Nurse and Social Worker, and provides Care Advisory Services. Care Advisory
Services are those provided in the Needs Assessment, plus assistance with the
implementation of a long term care service plan.
Note that no Maximum Benefit Amount is applied if the insurance company selects
the Care Management Organization for the Needs Assessment. If, however, you select
the Care Management Organization, the Maximum Benefit Amount applies. |
Informal Caregiver Training Benefits
The provisions in the sample long term care insurance policy clearly state the specific
conditions under which benefits will be paid. Most policies contain provisions similar to those
outlined below.
______________
We will pay up to the Maximum Benefit Amount for Informal Caregiver Training,
shown on the Schedule of Benefits page, for the actual charges You incur to train an
nformal Caregiver to perform Maintenance or Personal Care services for You in Your
Home. This training can take place while You are at Home, or in a Hospital,
Nursing Home, Hospice facility or Assisted Living Facility, to make it possible for You
to return Home and be cared for by the person who received the training. We will not pay
for training someone who will be paid under the terms of this Policy to care forYou.
You do not need to satisfy the Elimination Period for this Benefit to be
payable. Receipt of this service will not count toward satisfying the Elimination Period.
Payment of this Benefi will reduce Your Total Lifetime Benefit.
COMMENT: An Informal Caregiver is a
person who provides Maintenance or Personal Care, but not as a Formal
Caregiver. Members of the
Insured’s Immediate Family qualify as Informal Caregivers Friends and other
relatives also may serve as Informal Caregivers.
Note that this training is covered only if the training is not for someone who
will be paid policy benefits for providing services of any kind. This benefit is not available for
training to perform services that are compensable under this policy.
Note that, unlike Needs Assessment, payment of this benefit will
reduce your Total Lifetime Benefit.
Both of these Additional Services (Needs Assessment Benefits, Informal Caregiver
Training Benefits) have their own lifetime Maximum Benefit Amounts. It is not a
daily benefit. The lifetime Maximum Benefit Amount for each is usually somewhere between
$250 and $750. | | 
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