LTC GLOSSARY

Rider/Provision Definition

• Bathing – ability to wash oneself, either in the tub, shower, or by sponge

Activities of Daily Living (ADLs)
Adult Day Care Facility
Alternate Plan of Care
Alzheimer's Disease
Assisted Living Facility
• Continence – ability to control one’s bladder or bowel movements
• Dressing – ability to change one’s clothes and any necessary braces,
fasteners, or artificial limbs
• Eating – ability to feed oneself from a receptacle (such as a plate, cup, or
table) or by feeding tube or intravenously
• Toileting – ability to get to and from/ on and off the toilet and performing
associated personal hygiene
• Transferring – ability to move into and out of bed, chair, or wheelchair
Usually the inability to perform 2 or more ADLs will trigger benefits in an LTC
policy
State-licensed facility with a full-time director and registered nurse present
at least 4 hours a day - not an overnight facility. Daycare facilities maintain
written records of services, are open a minimum number of hours per day at
least 5 days per week, and have established procedures for handling medical
emergencies.
A plan of care developed by a health professional as an alternative to
entering a nursing home or care facility (i.e. religious reasons)
A progressive, degenerative type of dementia that causes severe intellectual
deterioration
A residential living arrangement that provides individualized personal care
and health services for people who require assistance with activities of daily
living. Facility settings can range from small homes to large apartment-style
complexes. Levels of care and services also vary and can be charged
separately. Assisted living facilities offer a way to keep a relatively
independent lifestyle for people who don’t need the level of care provided
by nursing homes

When a patient leaves a facility to go to the hospital, this provision will pay
Bed Reservation
to reserve the facility's bed so the patient can return when the hospital stay
is over. Most policies have a calendar year limit (i.e. 30 days)
Determined by the total benefit pool should the monthly/daily benefit
Benefit Period maximum be used up. Monthly/daily benefits that are not fully used can
carry over - thereby extending the actual benefit period.
Conditions that must be met before the policy pays benefits. Most common
Benefit Triggers triggers include inability to perform 2 or more ADLs and/or cognitive
impairment
 Your LTC Policy's Quarterback/Playcaller - Usually a representative from the
insurance company - Evaluates the patient's need for care and determines
Case Manager the best type of care for his/her situation. Case Managers often help the
insurer by controlling costs and help the insured by identifying resources
available in the community.
Pays a fixed amount directly to the insured while they qualify for care. This
amount (usually 30-40% of monthly benefit) can be used to pay for expenses
Cash Benefit
that may not be covered under the reimbursable benefit (i.e. family member
assistance).
A deficiency in a person's short or long-term memory; orientation
Cognitive Impairment concerning person, place, time; deductive or abstract reasoning; or
judgment as it relates to safety awareness.
Provides options to the insured in the event of a rate increase. (1) Pay the
higher premium for the same coverage (2) Pay the same premium for
Contingent Nonforfeiture decrease benefit levels (3) Convert to a paid-up policy with a shortened
benefit period. [As defined by the National Association of Insurance
Commissioners (NAIC)]
Care that can be given by a person without medical training - usually to
Custodial Care
assist with ADLs
Law passed in 2005 that tightens eligibility for Medicaid payment for LTC
Deficit Reduction Act
services - changed the lookback period to 5 years.
Dementia Deterioriation of intellectual faculties due to a disorder of the brain

A type of deductible - the length of time the individual must pay for covered
services before the policy begins paying benefits. LTC policies can use
Elimination Period "Calendar-Day" or "Service-Day" Elimination Periods. Calendar-Day EPs will
pay benefits after a 90 day wait. Service-Day EPs will only count days when
service is incurred towards the EP. Ninety days of service either through
Home Health Care or in a facility will exhaust the EP on these contracts.
Policies with this language cannot be canceled by an insurance company
Guaranteed Renewable except for non-payment. The insurance company may increase premiums,
but only on an entire class of policies.
Physical assistance without which the individual would not be able to
Hands-On Assistance
perform ADLs
Formal paid health care services provided in the home by a nurse or other
Home Health Care licensed professional (i.e. home health aide, nutritionist, physical therapist,
etc.)
Assistance with chores or activities that are necessary for an individual to be
Homemaker Services
able to remain in their residence
Hospice Care Care for a terminally ill person (life expectancy less than 6 months)
Inflation Protection Cost of Living Increases - Usually Compound or Step-Rated
Informal Care Care provided by friends or family
Care for stable conditions requiring daily but not 24-hour supervision. Less
Intermediate Nursing Care
intensive than skilled care, supervised by registered nurses

Medicaid
Medicare
Medicare Supplement/Medigap
Partnership Policy
Respite Care
Return of Premium
Shared Care
Shortened Benefit Period
Skilled Nursing Facility (SNF)
Spend Down
Standby Assistance
Substantial Assistance
Substantial Supervision
Joint Federal/State government program that pays for health care services
for those with low incomes or very high medical bills relative to income and
assets
Federal government program that provides health insurance to individuals
age 65 and up (and certain disabled persons). After a 3-day inpatient
hospital stay, Medicare covers Skilled Nursing Facility Care for 20 days at
100% and an additional 80 days with a copay. Medicare does NOT pay for
custodial care or most other LTC services
A supplemental policy that pays for care approved by Medicare but not fully
covered. Medicare supplements do not pay for services not covered by
Medicare
If an LTC Policy is Partnership Qualified, it allows the insured to protect some
of his/her assets. After the insured exhausts their LTC policy benefits, he/she
can apply for Medicaid. The benefit pool of the policy (i.e. $150k) is how
much the insured can keep in assets after spending down. States vary in
specific requirements for what qualifies as a Partnership Policy.
Care provided by a third party that relieves family caregivers for a few hours
to several days
A cost rider that returns some or all of the insured's premiums at
cancellation or death. Each carrier has several Return of Premium rider
options - see the carrier's brochure for more information on how each rider
works.
Applies to couples only - allows an insured to use his/her partner's benefit
after exhausting their own specified benefit.
A benefit provided by a Nonforfeiture rider or Contingent Nonforfeiture
benefit - shortens the benefit period of the policy without taking from
daily/monthly maximums. For instance, if an insured pays for a 3 year
benefit period, and becomes subject to substantial rate increases, his benefit
period may be reduced to just one year of coverage.
A facility licensed and certified by the state that provides both skilled nursing
and personal care services. The care must be available 24 hours a day.
A requirement that an individual use up most of his/her income and assets
before qualifying for Medicaid benefits.
The presence of another person within arm's reach - necessary to prevent
injury while the individual is performing an ADL.
Most Tax-Qualified LTC policies require "Substantial Assistance" with ADLs as
a benefit trigger - can be defined as either "Hands-on assistance" or
"Standby Assistance"
Continual supervision that is needed to protect the individual from threats to
his/her health or safety. Most Tax-Qualified LTC policies require "Substantial
Supervision" over an insured with a cognitive impairment as a benefit trigger
 On a joint policy, if a partner passes, the benefits from his/her policy can be
Survivor Benefits used to "pay up" the surviving partner's policy. The surviving spouse will not
have to pay further premiums.
If an LTC policy meets the standards set by federal law, it offers certain
Tax-Qualified Policies federal tax advantages - premiums can be deducted on an itemized return to
a limit set by the IRS.
A benefit which lets the insured name someone whom the insurance
Third Party Notice
company can contact if the premium is not paid
A provision that relieves the insured of paying the premiums while receiving
Waiver of Premium
benefits.