Partnership LTC 4-Hour Refresher Course

Table of Contents

Chapter 1: Partnership Program Creation	1
Defining Long-Term Care	1
History of the Partnership for Long-Term Care	4
RWJF had specific goals	6
Partnership Policies Created	6
Chart: Original 4 Partnership State Programs	7
Medicaid Continues to be the Largest Nursing Home Payor	8
Chart: Dollar-for Dollar asset protection	10
The Deficit Reduction Act of 2005 Provides Asset Protection	11
OBRA 1993 Provisions Pertaining to the Partnership for Long-Term Care	12
Insurance Producers and Consumer Education	13
Policy Benefits	1
Inflation Protection	15
Reciprocity Between States	16
State Funding	16
Chapter 2: Program Benefits	17
Making Benefit Choices	17
Buying Decisions	18
Daily Benefit Options	19
Determining Benefit Length	20
Asset Protection in Partnership Policies	20
Policy Structure	21
Home Care Options	21
Inflation Protection	21
Simple and Compound Interest	22
Required Rejection Forms (in some states)	23
Elimination Periods in LTC Policies	23
Policy Type	24
Restoration of Policy Benefits	24
Preexisting Periods in Policies	24
Medicare Prior Hospitalization Requirements for Skilled Care	25
Deciding Between Federal Tax-Qualified or State Non-Tax Qualified (Non-Partnership) Policies	25
Nonforfeiture Values	26
Waiver of Premium	27
Unintentional Lapse of Policy	27
Policy Renewal Features	28
Items Not Covered by the LTC Policy	28
Extension of Benefits	29
Affordability of Contracts	29
Standardized Definitions	29
Minimum Partnership Requirements	29
Benefit Duplication	30
Partnership Publication	30
Policy Abbreviations	30
Truly a Partnership	31
Saving Assets from Medicaid Qualification	32
Accessing Policy Benefits	33
Medicaid Estate Recovery	36
Asset Repositioning for Medicaid Qualification	38
Partnership Participation Does Not Guarantee Medicaid Qualification	38
Chapter 3: Basic Policy Considerations for Traditional LTC Policies	39
Policy Issue	39
Qualified LTC Partnerships under DRA 2005 & Expansion of State LTC Programs	40
Definition of Qualified State LTC Partnership Policy	40
Meeting Partnership Eligibility Requirements	41
Grandfather Clause	43
NAIC Model Regulations	43
Partnership Plans Protect Assets, Never Income	44
Age as an LTC Policy Factor	44
Reducing Benefits to Save Premium	45
Policy Renewal	46
Policy Review: 30 Day “Free Look”	47
“Notice to Buyer”	47
Policy Schedule	47
Understanding Policy Terms	48
Elimination Periods in Policies	52
Policy Termination	52
Mental Impairments of Organic Origin	53
Hospitalization Requirements	53
Home and Community Based Benefits	54
Bed Reservation Benefit	54
Waiver of Premium	55
Selecting Other Types of Care	56
No Policy Covers Everything	56
Age Misstatement	57
Third Party Notification	58
Reinstatement of a Lapsed Policy	58
Section 6021: Expansion of State LTC Partnership Programs	59
NAIC 2000 Model Act	61
“Level Premium” Does Not Mean Unchanging Rates	62
Financial Requirements for Rate Increases	63
Rate Certification from the Insurer’s Actuary	63
Consumer Disclosure	63
LTC Personal Worksheet	64
Is the Policy Suitable for the Buyer?	64
Consumer Publications	64
Post-Claim Underwriting	65
Tax-Qualified Policy Statement	65
Replacement Notices	66
Policy Conversion	66
An Overview	66
The Model Act Applies to All	67
Policy Renewable Provisions	68
Payment Standards Must be Defined	68
Preexisting Standards	68
Policy Type Must be Identified	68
Activities of Daily Living (ADL)	68
Life Insurance Policies with Accelerated Benefits	69
Nonforfeiture Provisions	69
Extension of Benefits	70
Home & Community Care	70
Additional Provisions for Group Policies	70
Outline of Coverage	70
Policy Delivery	71
No Field Issued LTC Policies	71
Policy Advertising and Marketing	71
No Policy Covers Everything	71
Prior to the Sale	72
Shopper’s Guide	72
Twisting and High-Pressure Tactics are Just Plain Illegal	72
Association Marketing	73
Following the Sale	73
Failure to Pay Premiums	73
In Conclusion	73
Chapter 4: Financial Planning for Long-Term Care	75
The Importance of Planning	75
Factors Increasing Use of Long-Term Care	77
Chart: Average Costs in the US	79
States are Struggling to Deal with Medicaid Costs (Long-Term Care Trust Act)	80
Coverage of Long-Term Care Services	81
Chapter 5: Terminology	83

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Eatonville, Washington 98328