- Amount of the benefit: Most
policies pay a fixed amount for each day you are eligible for
the benefit; e.g.., $160 per day. A survey of nursing homes
in the local area can help determine the desired benefit.
- Inflation protection:
Since costs inevitably increase, a policy without a provision
for inflation may be outdated in a few years. Of course, and
additional charge is incurred for this protection.
- Guaranteed renewability:
This important provision will prevent the insurance company
from canceling your policy for as long as you continue to pay
the premium when it is due. However, the insurer may be able
to raise rates on a class basis. Currently, long-term care policies
sold in most states guaranteed renewable.
- Waiver of premium: Some
policies will waive the future premiums after you have been
in the nursing home for a specified number of days; e.g., 90
days.
- Prior hospitalization: This
policy provision requires one to be hospitalized (for the same
condition) prior to entering the nursing home, or no benefits
will be paid under the policy. Although prior hospitalization
clauses have been outlawed in all states, some older policies
still in force may contain provision. Policies currently sold
do not contain prior hospitalization clauses.
- Place of care: Does
the policy require that the nursing home be licensed or otherwise
certified by the state to provide skilled or intermediate nursing
care? Must the facility meet certain record keeping requirements?
- Plan of care: A plan
of care is part of the health care claims process. it is the
result of an assessment prepared by the insured's physician,
and a multi-disciplinary team, including practical nurses, social
workers, and other health care professionals. the plan outlines
the appropriate level of care needed to assist the insured in
performing the activities of daily living.
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