Respite Care 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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"Respite Care" means Covered Services from a Formal Caregiver that
provides temporary relief for the Informal Caregiver. These Covered Services may
be received in a Nursing Home, Hospice facility, Assisted Living Facility, at
Home, or in an Adult Day Care Center.
We will pay up to the Maximum Daily Benefit Amount for Respite Care shown on
the Schedule of Benefits page, for actual charges You incur, based on the type of service
received, for a maximum of twenty-one days per Policy Year.
If You receive more than one type of Respite Care service on the same day, the
Maximum Daily Benefit Amount payable is the highest Respite Care Daily Benefit
Amount that relates to the services rendered.
You do not need to satisfy the Elimination Period for Respite Care Benefits to
be payable. Receipt of Respite Care will not count toward satisfying the Elimination
Period. Payment of these Benefits will reduce the Maximum Daily Benefit
Amounts otherwise available.
| COMMENT: A "Formal Caregiver" can be a Nurse, Care Advisor, Therapist, Social
Worker, Home Health Aide, Homemaker or Certified Private Aide. Members of the Insured's
immediate family are not considered Formal Caregivers for insurance purposes. Formal
Caregivers must be either licensed or certified by the appropriate authority, or are employed
by a licensed or certified organization, such as a Nursing Home or a Home Health Care
Agency. Read our article on Policy Definitions for how a typical policy defines these terms. Note
that Respite Care can be provided in many different settings, not solely to relieve an
Informal Caregiver in the Home.
The Maximum Daily Benefit Amount for Respite Care is shown on the Schedule of Benefits page. This amount may be the same as
Maximums for Nursing Home, Assisted Living Facility, Hospice facility and Home Care and
Community Care, or it may be different. The Maximum Amount is only payable for 21 days
per Policy Year.
Unlike many of the other Services, Respite Care is not subject to the Elimination
Period, but neither does it count toward satisfying the Elimination Period.
With Home Care, the primary responsibility for care and companionship rests
with the family members. When an individual requires extensive monitoring, the burden on family
members, who must be ever-present and available, can be substantial. Some agencies provide
temporary Respite Care – a companion whose presence allows the family member to leave the
house to go to work, attend to other business, or simply have a break. Private arrangements may
also be made for Respite Care. This care serves another purpose, for it also provides a
break for the person receiving the care – the opportunity for a fresh face. |
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