RIDERS

Nonforfeiture Benefit
State insurance regulations often require that long-term care insurers offer nonforfeiture benefit riders and this option must be offered if you're buying a tax-qualified policy. This rider assures that you won't forfeit all of your benefits even if you stop paying premiums before making a claim. According to the United Seniors Health Cooperative, an independent consumer advocacy group, you'll pay in the neighborhood of 40 percent more for a policy with a nonforfeiture benefit rider attached to it which is usually not cost-effective for the client.

Return of Premium
A type of nonforfeiture benefit included in some long-term care policies or as a rider that provides a cash value accumulation and return of premiums in the future to insures who receive no policy benefits or minimal benefits while the policy is in force. Exact provisions vary from policy to policy, but generally provide a greater return the longer the policy is in force and usually deduct the amount of any claims paid before returning premiums to the insured. Some clients prefer this option as a hedge against not needing the insurance. Only recommended if the client can afford the additional premium, otherwise not cost-effective.

Share Benefit
A shared-benefit rider lets you extend the duration of your benefit if both spouses have coverage. If both the husband and wife have a policy, the rider lets either draw from the other's policy if their own benefits are exhausted. We recommend this rider to insure added protection when purchasing less than 8 years of coverage.

Inflation Protection
No matter which long-term care policy you buy, an inflation rider is an important option. These riders help ensure that your long-term care policy payments keep pace with the escalating cost of care. Because this coverage is so important, insurance regulators in many states require any purchaser of a long-term care policy to sign a special form indicating they are rejecting the inflation rider.

Waiver of Premium
Any provision included within or as a rider to an insurance policy providing that, when specified conditions exist, the policy will continue in force without further premium payment. When the specified conditions no longer exist. the insured person resumes paying premiums. This rider can come in handy on a joint policy when one insured begins receiving care.

Calendar Day Elimination Period (EP) Waiver of HHC
Elimination Period will be waive if you are receiving Home Health Care, Hospice Care, or Adult Day Care. The Elimination Period must still be satisfied before benefits are payable under Long-Term Care Benefit for confinement in a Nursing Home or an Assisted Living Facility. However, Days with the Home Health Care Elimination Period is waived will count toward meeting the facility Elimination Period. We highly recommend that this rider be added to all 60, 90 day EP plans

Restoration of Benefits
A long-term care policy may reinstate benefits you have used, after you have stopped needing care for a prescribed number of days. For example, if you have a 3-year benefit policy, receive benefits for one year, then do not require care for six months, the policy will "restore" a year of benefits which means you still have 3 more years of coverage. If a policy offers restoration of benefits, check to see what percentage of the benefit is restored and how long you must be free of treatment for benefits to be restored.

*Please note that each company's long term care insurance policy will have it's own definitions of these terms. Our recommendations are generalizations and it is imperative that you speak with your long term care insurance specialist regarding these recommendations and which benefits are most appropriate for your own situation before purchasing your policy.

GLOSSARY

Activities of Daily Living (ADLs): Everyday actions performed by individuals such as dressing, eating, bathing, toileting, continence and transferring. Most insurance policies covering long term care services base your qualification for benefits on your inability to perform a certain number of ADLs.

Adult Day Care: Group supervision for elderly persons, including social and recreational services and in some cases health services, in a community facility.

Alternate Level of Care Benefits: Care in a hospital inpatient setting for those persons waiting to be placed in a nursing home or while arrangements are being made for home care.

Assisted Living Facility: A residential facility providing ongoing care and related services for persons needing assistance in the activities of daily living.

Custodial Care: Non-medical care that meets your personal needs. For example, custodial care includes help eating, bathing, toileting, taking medication or walking.

Cognitive Impairment: Deterioration in intellectual activity such as thinking, reasoning or remembering.

Daily Benefit Amount: The amount your insurance policy will cover for each day of services provided. Some policies pay a flat daily benefit amount, while others will pay reasonable and customary charges up to the daily benefit amount.

Dementia: Impairment of intellectual faculties due to a disorder of the brain.

Elimination or Waiting Period: The elimination or waiting period is the number of days you must receive long term care services before benefits will be paid under the policy. During the elimination or waiting period you will have to privately pay for the care you receive. A new elimination or waiting period may be imposed for each period of care. Shorter periods increase the cost of coverage.

Free Look Period: The time period after receipt of the policy during which a policyholder can cancel and get a full refund. In New York State this period is 30 days for tax-qualified policies and from 10 to 30 days for non-tax-qualified policies.

Guaranteed Renewable: Guaranteed renewable means that you have the right to continue the policy as long as the premiums are paid on a timely basis. An insurer cannot terminate the policy if your health declines. The insurer also cannot make any change in any provision of the policy while the insurance is in force without your agreement. An insurer cannot change the premium charged for the policy unless it is approved by the New York State Insurance Department, and unless it applies to all members of a class covered by the policy.

Home Care (personal care): Assistance with personal hygiene, dressing or feeding, nutritional or support functions and health-related tasks.

Home Health Care: Health services received in your home, including skilled nursing care, speech, physical or occupational therapy or home health aide services.

Hospice Care: A program of care and treatment, either in a hospice facility or in the home, for persons who are terminally ill and have a life expectancy of six months or less.

Inflation Protection Benefit: Increases the daily benefit amount and policy maximums over time to help keep pace with inflation and increased expenses.

Maximum Policy Benefit: The period of time or dollar amount limit for which long term care benefits will be paid under the policy.

Medicaid: A governmental program for low-income individuals and families.

Medicare: A federal program providing hospital and medical insurance to people aged 65 or older and to certain ill or disabled persons.

Nonforfeiture Benefit: A benefit designed to ensure that if an insurance policy is lapsed after a specific number of years, some of the benefits from the policy will be retained.

Partnership for Long Term Care: A public-private partnership which combines private long term care insurance with Medicaid Extended Coverage. (Not available in Arizona)

Period of Care: A specified number of days of care either in a nursing home or while receiving home care services without a break in the services for a specified number of days.

Respite Care: Services to provide family members a rest or vacation from caregiving responsibilities.

Skilled Nursing Care: A level of care that must be given or supervised by registered nurses.

Waiting Period: The number of days you must be in a nursing facility or the number of days of home health care you must receive before long term care benefits will be paid under the policy. During the waiting period, you must privately pay for the nursing facility stay or home health care services.

Waiver of Premium: After a policyholder has received benefits for the specific number of days stated in the policy, no further premiums will be due until they leave the nursing home.