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.

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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 Coverageunder this Policy, You must meet the following:

1. Be outside the United States and its territories;
2. Provide proof, satisfactory to Us, that You are Chronically Ill;
3. Be eligible for Benefitsunder this Policy;
4. Satisfy the Elimination Period for International Coverage; and
5. 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.

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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 Benefitspage.

“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 Servicesis 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.

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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.

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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 Coveragetimes 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 Benefitspage.

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.

Case Studies: International Long Term Care Coverage

Case Study 1: Per Diem Benefit for International Coverage

Mr. Smith, a policyholder with international coverage for long-term care insurance, requires care while traveling abroad. He meets all the eligibility requirements, including the two-times Elimination Period for International Coverage. As a result, Mr. Smith becomes eligible for the Per Diem Benefit.

With a Home Care and Community Care Maximum Daily Benefit of $150, Mr. Smith receives $75 per day, allowing him to access necessary care even without receiving specific covered services. This Per Diem Benefit provides flexibility and support for policyholders requiring long-term care outside the United States.

Case Study 2: Elimination Period for International Coverage

Ms. Johnson, another policyholder with international long-term care coverage, finds herself in need of care while residing overseas. As per the terms of her policy, the Elimination Period for International Coverage is twice the standard Elimination Period.

Each day that Ms. Johnson is eligible for benefits while outside the United States and its territories counts toward satisfying the Elimination Period for International Coverage. Importantly, Ms. Johnson does not need to receive covered services during this period, providing her with greater flexibility in accessing care abroad.

Case Study 3: Total Lifetime Benefit for International Coverage

In this case, Mr. Brown has a long-term care insurance policy with international coverage that includes a Total Lifetime Benefit. His policy specifies that the Total Lifetime Benefit is the lesser of the amount shown on the Schedule of Benefits page minus any benefits received in the United States and its territories, or the Per Diem Benefit for International Coverage multiplied by 3,650.

By carefully managing his benefits and considering the limitations, Mr. Brown ensures that his total lifetime benefits do not exceed the coverage specified in his policy, whether received within or outside the United States and its territories.