Claims for International Long Term Care Coverage
The provisions in the sample long term care insurance policy clearly state the specific
conditions under which benefits will not be paid. Most policies contain provisions similar to
those outlined below.
If You are making a claim for Benefits under the International Coverage section of this
Policy, any reference above to either charges You incur for Covered Services or to claim
forms does not apply.
COMMENT: The one unique requirement that you must satisfy to be eligible for
payment of Benefits for International Coverage is that you must be outside the United States and
its territories. All other eligibility requirements for payment of Benefits are the same as when you
are in the United States or its territories.
The above provision states that, as pertains to International Coverage, references
to "charges you incur for Covered Services" or to "claim forms" may be disregarded because
they don't apply. The reason is that Benefits for International Coverage are paid in a
different way. Benefits for International Coverage are paid on simple per diem basis. The
Per Diem Benefit is not related to charges you incur. All you need to do is to show that
you are eligible for payment of Benefits for International Coverage and you will be paid a
pre-determined daily benefit amount. The Amount is 50% of the Home Care and Community Care
Maximum Daily Benefit Amount shown on the Schedule of Benefits page of the Policy.
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