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.
"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 Amountthat 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 Amountsotherwise 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.