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Home > Law Advice > Long Term Care > Extension Of Long Term Care Benefits
Long Term Care
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Long Term Care Extension of 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.

______________

If, as of the date Your Policy Lapses or as of the date We receive a written request to cancel Your policy, You are eligible for Benefits and are confined in a Nursing Home, Hospice facility or Assisted Living Facility, We will extend the payment of Benefits for Covered Services received so long as, without interruption, You remain eligible for Benefits and remain confined. Subject to the Elimination Period and the terms of this Policy, Benefits will be extended only until the earliest of the date:

  1. You are no longer eligible for Benefits; or
  2. You are no longer confined in a Nursing Home, Hospice facility or Assisted Living Facility; or
  3. Your Total Lifetime Benefit has been paid.

COMMENT: A long term care insurance policy Lapse means the policy has been terminated because of a failure to pay premiums. The policy actually terminates 35 days after the end of the grace period for paying the premium. The grace period is usually 31 days after the premium due date.

To summarize, to be eligible for Benefits, you must be certified to be Chronically Ill and you must have a Plan of Care in place, including the Qualified Long Term Care Services.

Not only must you be eligible, you must also be confined in one of the three facilities mentioned above, so, if your long term care insurance coverage Lapses OR you request to cancel your policy AND you are eligible for Benefits AND you are confined, the insurance company will continue the payment of Benefits for Covered Services.

Covered Services are diagnostic, preventive, therapeutic, curing treating, mitigating and rehabilitative services, and Maintenance or Personal Care Services. Maintenance or Personal Care Services is basically any care that provides needed assistance when you are Chronically Ill, including Custodial Care and assistance with Activities of Daily Living (bathing, dressing, transferring to and from bed or chair, toileting, continence and eating).

If you are no longer confined at the facility, your Extended Benefit coverage stops and your coverage under the policy ends. Your Extended Benefits will also end if you are no longer eligible for Benefits. This might happen if you recover sufficiently to no longer be considered Chronically Ill. Finally, if your Total Benefit Limit shown on the Schedule of Benefits page is reached, all of your benefits, including your Extended Benefits, will stop.

Extended Benefits are really nothing more than the normal benefits that would be available to you if you were paying the premium. You might wonder why you should keep paying the premium once you are eligible for Benefits and confined in a qualifying facility. If you are certain that you are not going to recover sufficiently to leave the facility or to lose your eligibility for Benefits, you probably should discontinue paying premiums and avail yourself of the Extended Benefits. But if you think you might recover, you would be wise to continue to pay the premium. If you stop, you will be without long term care insurance and will have to re-apply for a new policy when you recover. Any new policy is subject to underwriting, based on your current age and health when you re-apply. A new policy will probably be far more expensive than your current policy – if you can get it at all.


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Sample Cover Page for Long Term Care Insurance Policy

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Waiver of Premiums and Reinstatement of Long Term Care Policy and Cognitive Impairment

Long Term Care Claims: Notice, Forms, Proof

Claims for International Long Term Care Coverage

Processing Claims: Physical Examination, Denials, Payments

General Provisions of Long Term Care Policy

Long Term Care POLICY RIDERS: Inflation Protection

Policy Riders: Lapse Rider, Contingent Benefits and Contingent Nonforfeiture Coverage

Long Term Care Policy Riders: Paid Up Premiums

Long Term Care Extension of Benefits

Changing Benefit Amounts in a Long Term Care Insurance Policy

Long Term Care Insurance Policy Schedule of Benefits

Eligibility For Payment of Long Term Care Insurance Benefits

Elimination Period

Covered Services -- Primary Services and Additional Services—Under Long Term Care Policy

Nursing Home, Hospice Facility and Assisted Living Facility Benefits

Home Care and Community Care Benefits

Respite Care Benefits

Alternate Service Benefits

Additional Services: Needs Assessment Benefits, Informal Caregiver Training Benefits

International Long Term Care Coverage

The Application Process and Underwriting of an Individual Long Term Care Policy

Related Information
» Long Term Care Insurance Articles
» Buying Long Term Care Insurance
» Problems, Denials and Lawsuits
» Sample Long Term Care Policy and Provisions
» What to Look for in a Long Term Care Policy
» Who Needs Long Term Care Insurance

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