Specific provisions in a typical long term care insurance policy govern your eligibility for benefits. These are defined below, with additional comment for clarification where needed.
In order to be eligible for certain Benefits, you must also satisfy an Elimination Period, as described below.
“Elimination Period” is the number of days after the Original Coverage Effective Date of this Policy during which You must be: (1) Chronically Ill; and (2) receiving Primary Services (other than Hospice Care and Respite Care), before certain Benefits become payable. These days need not be consecutive. The Elimination Period for this Policy is shown on the Schedule of Benefits page. Except as stated below, Benefits will not be paid for Covered Services You receive during the Elimination Period.
No Elimination Period is required in order to receive Benefits for Hospice Care, Respite Care, Needs Assessment or Informal Caregiver Training. Receipt of these services will not count toward satisfying the Elimination Period.
You only have to satisfy the Elimination Period once. Once You have satisfied a day of the Elimination Period, that day is satisfied for the life of the Policy.
COMMENT: The Elimination Period in this long term care Policy is like a waiting period or a deductible period in your typical health insurance policy. Subject to the exceptions stated above, no long term care benefits are covered under the Policy during this period. You are responsible for paying all long term care costs incurred during the Elimination Period.
This is an important aspect to consider when buying a long term care insurance policy. Elimination periods range from 10 days to one year. Generally, you can decide what the length of your Elimination Periodwill be, but it affects the cost of the premium. The shorter the elimination period, the higher your premium will be; the longer the elimination period, the lower the premium will be. A typical elimination period is around 60 days, but if you elect an elimination period of 6 months to one year, you might reduce your premium by as much as a third.
Your decision on the length of the Elimination Period must take into consideration your ability to pay for long term care expenses AND, along with it, the quality/cost of the long term care facility you would consider. In many situations an older person only needs care for a short period of time. A long Elimination Period could mean you would not receive any Benefits at all. But the real purpose of long term care insurance is not to cover the costs of a short period of care, but to prevent the potentially financially devastating costs of a long period of expensive care. That’s why it is called long term care insurance. Therefore, purchasing a policy with a longer Elimination Period (90 days to 180 days) probably makes good sense if it results in substantial premium savings. This is particularly true if you are buying the policy when you are in your 50s or 60s and will probably be paying the premium for many years.
COMMENT: The Primary Services that count toward your Elimination Period are shown on the Schedule Page of the Policy and are as follows: (1) Nursing Home services; (2) Assisted Living Facility services; and (3) Home Care and Community Careservices.
Other care described in the Policy does not count toward reducing your Elimination Period, nor are other services (such as, Respite Care, Hospice Care, Needs Assessment and Informal Caregiver Training) subject to the Elimination Period.