Partnership Long-Term Care Policies

4-Hour Refresher Course

 

 

Table of Contents

 

Table of Contents to be used as an outline, page numbers will not match online book.

 

Chapter 1: Partnership Program Creation

6

Defining Long-Term Care

7

History of the Partnership for Long-Term Care

10

     RWJF had specific goals

13

Partnership Policies are Created

14

     Chart: Original 4 Partnership State Programs

15

Medicaid is the Largest Nursing Home Payor

16

     Chart: Dollar-for Dollar asset protection

19

The Deficit Reduction Act of 2005 Provides Asset Protection

20

OBRA 1993 Provisions Pertaining to the Partnership for LTC

21

Agent and Consumer Education

23

Policy Benefits

25

Inflation Protection

25

Reciprocity Between States

26

State Funding

27

Chapter 2: Program Benefits

28

Making Benefit Choices

28

     Buying Decisions

29

Daily Benefit Options

30

Determining Benefit Length

32

Asset Protection in Partnership Policies

32

Policy Structure

33

Home Care Options

34

Inflation Protection

34

Simple and Compound Interest

35

Required Rejection Forms (in some states)

36

Elimination Periods in LTC Policies

36

Policy Type

37

Restoration of Policy Benefits

38

Preexisting Periods in Policies

38

Medicare Prior Hospitalization Requirements for Skilled Care

39

Deciding Between Federal Tax-Qualified & State Non-Tax

   Qualified (Non-Partnership) Policies

39

Nonforfeiture Values

40

Waiver of Premium

41

Unintentional Lapse of Policy

42

Policy Renewal Features

42

Items Not Covered by the LTC Policy

43

Extension of Benefits

44

Affordability of Contracts

44

Standardized Definitions

44

Minimum Partnership Requirements

45

Benefit Duplication

45

Partnership Publication

45

Abbreviations

46

Truly a Partnership

47

Saving Assets from Medicaid Qualification

48

Accessing Policy Benefits

49

Asset Repositioning

52

Partnership Participation will not Guarantee Medicaid Qualification

53

Chapter 3: Basic Policy Considerations for

                  Traditional LTC Policies

55

What is a Traditional Long-Term Care Policy?

55

Policy Issue

56

Qualified LTC Partnerships under DRA 2005

57

Definition of Qualified State LTC Partnership Policy

57

Meeting Partnership Eligibility Requirements

58

Grandfather Clause

60

NAIC Model Regulations

60

Partnership Plans Protect Assets, Not Income

61

Age as an LTC Policy Factor

62

Reducing Benefits to Save Premium

63

Policy Renewal

64

Policy Review: 30 Day “Free Look”

65

“Notice to Buyer”

65

Policy Schedule

66

Policy Terminology

66

Policy Termination

72

Mental Impairments of Organic Origin

72

Hospitalization Requirements

73

Home and Community Based Benefits

74

Bed Reservation Benefit

74

Waiver of Premium

75

Selecting Other Types of Care

76

No Policy Covers Everything

76

Age Misstatement

78

Third Party Notification

78

Reinstatement of a Lapsed Policy

79

Section 6021: Expansion of State LTC Partnership Program

80

NAIC 2000 Model Act

82

     “Level Premium” Does Not Mean Unchanging Rates

84

     Financial Requirements for Rate Increases

84

     Rate Certification from the Insurer’s Actuary

85

     Consumer Disclosure

85

     LTC Personal Worksheet

85

     Is the Policy Suitable for the Buyer?

86

     Consumer Publications

86

     Post-Claim Underwriting

87

     Tax-Qualified Policy Statement

87

     Replacement Notices

88

     Policy Conversion

88

An Overview

89

The Model Act Applies to All

89

     Policy Renewable Provisions

90

     Payment Standards Must be Defined

91

     Preexisting Standards

91

     Policy Type Must be Identified

91

     ADLs

91

     Life Insurance Policies with Accelerated Benefits

92

     Nonforfeiture Provisions

92

     Extension of Benefits

93

     Home & Community Care

93

     Additional Provisions for Group Policies

93

     Outline of Coverage

93

     Policy Delivery

94

     No Field Issued LTC Policies

94

     Policy Advertising and Marketing

94

     No Policy Covers Everything (Again)

94

     Prior to the Sale

95

     Shopper’s Guide

95

     Twisting, high pressure Tactics: Just Plain Illegal

95

     Association Marketing

96

     Following the Sale

96

     Failure to Pay Premiums

96

     In Conclusion

97

Chapter 4: Financial Planning for LTC

98

The Importance of Planning

98

     Factors Increasing Use of Long-Term Care

100

     Average Costs in US

103

          Chart: Long-Term Care Services

104

Chapter 5: Terminology

106-112

 

 

United Insurance Educators, Inc.

8213 – 352nd Street East

Eatonville, Washington 98328-8638

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