International Long Term Care Coverage
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 Benefits for International Coverage if You qualify under the
conditions defined in this section. "International" means any location outside of the
United States and its territories.
Eligibility for Payment of Benefits for International Coverage
In order to receive payment for Benefits for International Coverage under this Policy,
You must meet the following:
- Be outside the United States and its territories;
- Provide proof, satisfactory to Us, that You are Chronically Ill;
- Be eligible for Benefits under this Policy;
- Satisfy the Elimination Period for International Coverage; and
- Provide a written Plan of Care that includes the Qualified Long Term Care
Services You need.
| COMMENT: These are basically the same as the eligibility requirements as for coverage
within the US and its territories except you must be outside the US and its territories and the
Elimination Period is longer. |
Per Diem Benefit for International Coverage
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.
______________
The Per Diem Benefit that We will pay for International Coverage is equal to
fifty percent of the Home Care and Community Care Maximum Daily Benefit Amount shown on the
Schedule of Benefits page.
"Per Diem Benefit" means a Benefit computed on a daily basis regardless of
actual charges You incur and paid to You if You are eligible under this Policy to receive
Benefits for International Coverage. You do not need to receive Covered
Services in order to receive the Per Diem Benefit.
If You are receiving the Per Diem Benefit for International Coverage, You cannot
receive any other Benefits under this Policy for the same period of time. Coverage for
Additional Services is not available outside the United States and its territories.
The Per Diem Benefit will be paid to you in United States dollars. You may not assign
the Per Diem Benefit.
COMMENT: Note that you do not need to receive Covered Services in order to receive this special Per Diem Benefit.
Also note that you cannot receive any other Benefit under the Policy while you are
receiving this Per Diem Benefit.
Here is an example of how this Benefit works. If the Home Care and Community Care
Maximum Daily Benefit is $150, then the Per Diem Benefit is $75. If the Elimination
Period shown on the Schedule of Benefits page is 100 days, then the Elimination
Period for International Coverage is 200 days. Once you meet the 5 eligibility
requirements listed above, including the 200 day Elimination Period, you can begin receiving $75 per day even if you are not
receiving any Covered Services. While you are receiving this Benefit you cannot
receive any other Benefit under the Policy. |
Elimination Period for International Coverage
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.
______________
The Elimination Period for International Coverage is two times the Elimination
Period shown on the Schedule of Benefits page. Each day on which You are eligible for
Benefits under this Policy while You are outside of the United States and its territories
will count toward satisfying the Elimination Period for International Coverage. You do not
need to receive Covered Services in order to satisfy the Elimination Period for
International Coverage.
| COMMENT: Unlike the Elimination Period requirement for Primary Care
Benefits, you do not need to be receiving Covered Services to satisfy this Elimination Period. You just need to
be eligible for this Benefit. |
Total Lifetime Benefit for International Coverage 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 You Benefits for International Coverage up to the lesser of: (1) Your
Total Lifetime Benefit shown on the Schedule of Benefits page less any
Benefits paid while You are in the United States and its territories; or (2) the Per
Diem Benefit for International Coverage times 3,650.
The sum of all Benefits We will pay while You are in the Untied States and its
territories and outside the United States and its territories will never exceed the Total
Lifetime Benefit shown on the Schedule of Benefits page.
| COMMENT: Here is an example of how the Total Lifetime Benefit for International
Coverage works. Assume the Total Lifetime Benefit shown on the Schedule of
Benefits page is $200,000 and your Per Diem Benefit is $75. Your Total Lifetime
Benefit is the lesser of $200,000 or $75 x 3,650, which is $273,750. So, in this case, your
Total Lifetime Benefit is $200,000. 3,650 is the equivalent of 10 straight years of daily
benefits. |
Filing claims for international coverage is covered at Claims for International Coverage Title: Claims for International Coverage. | 
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