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home | Insurance | What Is A Long-Term Care Waiting Per . . .

What Is A "Long-Term Care Waiting Period?"

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Unfortunately for all of us, there is no official and universal definition of a "waiting period," an "elimination period," or a "deductible period" for long-term care insurance. Each company providing this kind of insurance can choose which words they will use and how they will define them. This is something that not very many prospective buyers of long-term care insurance understand, and it's something that far too few agents explain.

Generally, things shake out like this:

First, the insured person must be evaluated by the insurance company (either in person, by phone, or by medical documentation). Only after the insurance company certifies that the insured is eligible to receive benefits does the elimination period begin.

In order to receive credit during the elimination period, the insured person must often be receiving paid care from caregivers who meet the insurance company criteria (i.e., a licensed home care agency, or a certain kind of long-term care facility, and so on). Going without care during this time, receiving care from family members, or receiving care in a hospital, doesn't always count toward the long-term care insurance policy waiting period. It depends on how the policy is written.

Among the many ways a LTC insurance company can define "days of care," the most common are:

1. The actual days, and only those days, on which the individual receives care. If the insured receives care three days a week, then he or she only receives waiting period credit for those three days;

2. Some companies will give credit for an entire week if care is received on a certain number of days in that week;

3. Some (fewer) companies will count every day the insured is "qualified" to receive care, whether care was received or not.

Many agents are not as well trained as they should be, and any verbal explanation they give you is not binding on the insurance company. If the language in your Long-Term Care policy is confusing (most are) ask the company for a written explanation. You may or may not get it, because the lawyers are in charge of everything that goes out in writing, but it certainly can't hurt to ask. If you can't get a clear explanation of any part of a policy you are considering, then it might be a good idea to keep looking.

One of these days long-term care policies may be standardized, but I don't believe I'll personally live long enough to see it.



·  Understanding a Long Term Care Insurance Policy: What You Need to Know Before You Make Plans to Use Your LTC Policy