EXHIBIT ONE

TYPICAL LONG-TERM CARE SERVICES AVAILABLE

LONG TERM CARE SERVICES

Adult Companion Services. Companions assist or supervise the enrollee with tasks such as meal preparation or laundry and shopping, but do not perform these activities as discreet services.

Adult Day Health Services. Services are furnished in an outpatient setting and encompass a broad range of health and social services needed to ensure optimal functioning of an enrollee.

Assisted Living Services. Service includes personal care services, homemaker services, chore services, attendant care, companion services, medication oversight, and therapeutic social and recreational programming provided in a home-like environment in an assisted living facility.

Case Management Services. Services that facilitate enrollees gaining access to other needed services regardless of the funding source for the services, and which contribute to the coordination and integration of care delivery.

Chore Services. Services needed to maintain the home as a clean, sanitary, and safe living environment. This service includes heavy household chores such as washing floors, windows and walls, tacking down loose rugs and tiles, and moving heavy items of furniture in order to provide safe entry and exit.

Consumable Medical Supply Services. Disposable supplies provided to the enrollee and caregiver, which are essential to adequately care for the needs of the enrollee. Consumable medical supplies include adult disposable diapers, tubes of ointment, cotton balls and alcohol for use with injections, medicated bandages, gauze and tape, colostomy and catheter supplies, and other consumable supplies.

Environmental Accessibility Adaptation Services. Physical adaptations made to the home to allow the enrollee to function with greater independence in the home and without which the enrollee would require institutionalization. Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems to accommodate the medical equipment and supplies.

Escort Services. Escort providers assist enrollees in gaining access to services. Escorts may provide language interpretation for people who have hearing or speech impairments or who speak a language different from that of the provider. Escort providers assist enrollees in gaining access to services.

Family Training Services. Training and counseling services provided to the families of enrollees. Training includes instruction and updates about treatment regimens and use of equipment specified in the plan of care to safely maintain the enrollee at home.

Financial Assessment/Risk Reduction Services. Financial assessment and guidance provided to the caregiver and enrollee. This service provides instruction for and/or actual performance of routine, necessary, monetary tasks for financial management such as budgeting and bill paying. In addition, this service also provides financial assessment to prevent exploitation by sorting through financial papers and insurance policies and organizing them in a usable manner. This service provides coaching and counseling to enrollees to avoid financial abuse, to maintain and balance accounts that directly relate to the enrollee's living arrangements at home, or to lessen the risk of nursing home placement due to inappropriate money management.

Home Delivered Meals. Nutritionally sound meals delivered to the residences of enrollees who have difficulty shopping for or preparing food without assistance. Each meal must provide one-third of the Recommended Dietary Allowance (RDA) and may be hot, cold, frozen, dried, canned or a combination of hot, cold, frozen, dried, or canned with a satisfactory storage life.

Homemaker Services. General household activities (meal preparation and routine household care) provided by a trained homemaker.

Nutritional Assessment/Risk Reduction Services. Nutritional assessment and guidance for both caregivers and enrollees.

Nursing Facility Services. Services furnished in a health care facility licensed under  DelawareStatutes. Care is provided 24-hours a day in a nursing facility and includes all services necessary to meet client needs.

Occupational Therapy. Therapy provided to restore, improve or maintain impaired functions to increase or maintain the enrollee's ability to perform tasks required for independent functioning as determined through a multi-disciplinary assessment to improve an enrollee's capability to live safely in the home setting.

Personal Care. Assistance provided to the enrollee to eat, bathe, dress, maintain personal hygiene, and participate in activities of daily living. This service includes assistance with meal preparation, but does not include the cost of the meals. This service may also include housekeeping chores such as bed-making, dusting and vacuuming, which are essential to the health and welfare of the enrollee, rather than the enrollee's family.

Personal Emergency Response Systems (PERS). The installation and monitoring of electronic devices that allows enrollees at high risk of institutionalization to secure help in an emergency.

Physical Therapy. Therapy provided to restore, improve or maintain impaired functions determined through a multi-disciplinary assessment to improve an enrollee's capability to live safely in the home setting.

Respite Care Services. Short term relief provided to an enrollee's caregiver. Respite care is provided in the home/place of residence, Medicaid licensed hospital, nursing facility, or assisted living facility.

Speech Therapy. The identification and treatment of neurological deficiencies related to feeding problems, congenital or trauma-related maxillofacial anomalies, autism, or neurological conditions that affect oral motor functions to improve an enrollee's capability to live safely in the home setting.

Transportation Services. Transportation may be provided within Medicaid guidelines at the option of the contractor. These services cover arranging and providing appropriate modes of transportation for participants to receive necessary medical services.

 

ACUTE CARE SERVICES

Community Mental Health Services. Community-based psychiatric rehabilitative services provided by a psychiatrist or other physician.

Home Health Care Services. Intermittent or part-time nursing services provided by a registered nurse or licensed practical nurse, or personal care services provided by a licensed home health aide, with accompanying necessary medical supplies, appliances, and durable medical equipment.

Independent Laboratory and Portable X-ray Services. Medically necessary and appropriate diagnostic laboratory procedures and portable x-rays ordered by a physician or other licensed practitioner.

Inpatient Hospital Services. Medically necessary services provided under the direction of a physician or dentist in a hospital maintained primarily for the care and treatment of patients with disorders other than mental diseases.

Outpatient Hospital/Emergency Medical Services. Medical services provided in an outpatient center or emergency department necessary to maintain the health of the enrollee. These services include outpatient preventive, diagnostic, therapeutic, or palliative care provided under the direction of a physician at a licensed hospital and supplies necessary for the clinical treatment of a specific diagnosis or treatment.

Physician Services. Those services and procedures rendered by a licensed physician at a physician's office, patient's home, hospital, nursing facility or elsewhere when dictated by the need for preventive, diagnostic, therapeutic or palliative care, or for the treatment of a particular injury, illness, or disease.

Prescribed Drug Services. This service provides medications ordered by physicians. These services include all legend drugs dispensed (including Medicaid-reimbursable psychotropic drugs) to enrollees in outpatient settings.

Transportation is an optional rather than a required service. If they choose, providers can also offer expanded services such as vision and hearing services.

APPENDIX A

RESCISSION REPORTING FORM FOR

LONG-TERM CARE POLICIES

FOR THE STATE OF DELAWARE

FOR THE REPORTING YEAR 19[ ]

Company Name:___________________________________________

Address:______________________________________

Phone Number:__________________________________

Due: March 1 annually

Instructions:

The purpose of this form is to report all rescissions of long-term care insurance policies or certificates. Those rescissions voluntarily effectuated by an insured are not required to be included in this report. Please furnish one form per rescission.

Policy Form #

Policy and Certificate #

Name of Insured

Date of Policy Issuance

Date/s Claim/s Submitted

Date of Rescission

Detailed reason for rescission: ________________________________________________

____________________________________________________________________

Signature

__________________________________

Name and Title (please type)

__________________________________

Date

 

APPENDIX B

Long Term Care Insurance

Personal Worksheet

People buy long-term care insurance for a variety of reasons. Some don’t want to use their own assets to pay for long-term care Some buy insurance to make sure they can choose the type of care they get.  Others don’t want their family to have to pay for care or don’t want to go on Medicaid.  But long term care insurance may be expensive, and may not be right for everyone.

By state law, the insurance company must fill out part of the information on this worksheet and ask you to fill out the rest to help you and the company decide if you should buy this policy.

Premium Information

Policy Form Numbers____________________

The premium for the coverage you are considering will be [$_________ per month, or $_______ per year,] [a one-time single premium of $____________.]

Type of Policy (non-cancelable, guaranteed renewable):_____________________

The Company’s Right to Increase Premiums :

[The company cannot raise your rates on this policy.] [The company has a right to increase premiums on this policy in the future, provided it raises rates for all policies in the same class in this state.] [Insurers shall use appropriate bracketed statement. Rate guarantees shall not be shown on this form.]

Rate Increase History

The company has sold long-term care insurance since [year] and has sold this policy since [year]. [The company has never raised its rates for any long-term care policy it has sold in this state or any other state.] [The company has not raised its rates for this policy form or similar policy forms in this state or any other state in the last 10 years.] [The company has raised its premium rates on this policy form or similar policy forms in the last 10 years. Following is a summary of the rate increases.]

Questions Related to Your Income

How will you pay each year’s premium?

□From my Income □From my Savings/Investments □My Family will Pay

[□ Have you considered whether you could afford to keep this policy if the premiums went up, for example, by 20%?]

What is your annual income? (check one)

□Under $10,000 □$[10-20,000] □$[20-30,000]

□$[30-50,000] □Over $50,000

How do you expect your income to change over the next 10 years? (check one)

□No change □Increase □Decrease

If you will be paying premiums with money received only from your own income, a rule of thumb is that you may not be able to afford this policy if the premiums will be more than 7% of your income.

Will you buy inflation protection?( check one) □Yes □ No

If not, have you considered who you will pay for the difference between future costs and your daily benefit amount?

□From my Income □From my Savings/Investments □My Family will Pay

How are you planning to pay for your care during the elimination period? (check one)

□From my Income □From my Savings/Investments □My Family will Pay

Question Related to Your Savings and Investments

Not counting your home, about how much are all of your assets (savings and investments) worth? (check one)

□Under $20,000 □$20,000-$30,000 □$30,000-$50,000 □Over $50,000

How do you expect your assets to change over the next ten years? (check one)

□Stay about the same □Increase □Decrease

If you are buying this policy to protect your assets and your assets are less than $30,000, you may wish to consider other options for financing your long-term care.

Disclosure Statement

□The information provided above accurately describes my financial situation.

□I choose not to complete this information.

Signed:

(Applicant) (Date)

[□ I explained to the applicant the importance of completing this information.

Signed:

(Agent) (Date)

Agent’s Printed Name: ]

[Note: In order for us to process your application, please return this signed statement to [name of company], along with your application.]

[My agent has advised me that this policy does not appear to be suitable for me. However, I still want the company to consider my application.

Signed: ]

(Applicant) (Date)

Drafting Note: Choose the appropriate sentences depending on whether this is a direct mail or agent sale.

The company may contact you to verify your answers.

Drafting Note: When the Long-Term Care Insurance Personal Worksheet is furnished to employees and their spouses under employer group policies, the text from the heading “Disclosure Statement” to the end of the page may be removed.

 

APPENDIX C

Things You Should Know Before You Buy Long-Term Care Insurance

Long-Term Care Insurance	A long-term care insurance policy may pay most of the costs for your care in a nursing home. Many policies also pay for care at home or other community settings. Since policies can vary in coverage, you should read this policy and make sure you understand what it covers before you buy it.
	[You should not buy this insurance policy unless you can afford to pay the premiums every year.] [Remember that the company can increase premiums in the future.]

Drafting Note: For single premium policies, delete this bullet; for noncancellable policies, delete the second sentence only.

 

 

APPENDIX D

Long-Term Care Insurance Suitability Letter

Dear [Applicant]:

Your recent application for long-term care insurance included a “personal worksheet,” which asked questions about your finances and your reasons for buying long-term care insurance. For your protection, state law requires us to consider this information when we review your application, to avoid selling a policy to those who may not need coverage.

[Your answers indicate that long-term care insurance may not meet your financial needs. We suggest that you review the information provided along with your application, including the booklet “Shopper’s Guide to Long-Term Care Insurance” and the page titled “Things You Should Know Before Buying Long-Term Care Insurance.” Your state insurance department also has information about long-term care insurance and may be able to refer you to a counselor free of charge who can help you decide whether to buy this policy.]

[You chose not to provide any financial information for us to review.]

Drafting Note: Choose the paragraph that applies.

We have suspended our final review of your application. If, after careful consideration, you still believe this policy is what you want, check the appropriate box below and return this letter to us within the next 60 days. We will then continue reviewing your application and issue a policy if you meet our medical standards.

If we do not hear from you within the next 60 days, we will close your file and not issue you a policy. You should understand that you will not have any coverage until we hear back from you, approve your application and issue you a policy.

Please check one box and return in the enclosed envelope.

□ Yes, [although my worksheet indicates that long-term care insurance may not be a suitable purchase,] I wish to purchase this coverage. Please resume review of my application.

Drafting Note: Delete the phrase in brackets if the applicant did not answer the questions about income.

□ No. I have decided not to buy a policy at this time.

APPLICANT’S SIGNATURE  & DATE

Please return to [issuer] at [address] by [date].

APPENDIX E

Claims Denial Reporting Form

Long-Term Care Insurance

OMITTED

NOTE:  APPENDIX E is omitted in the Delaware regulations, and is shown here in case the future regulations require a specific Claims Denial Reporting Form.

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APPENDIX F

Instructions:

This form provides information to the applicant regarding premium rate schedules, rate schedule adjustments, potential rate revisions, and policyholder options in the event of a rate increase.

Insurers shall provide all of the following information to the applicant:

Potential Rate Increase Disclosure Form

1. [Premium Rate] [Premium Rate Schedules]: [Premium rate] [Premium rate schedules] that [is][are] applicable to you and that will be in effect until a request is made and [filed][approved] for an increase [is][are] [on the application][$_____])

Drafting Note: Use "approved" in states requiring prior approval of rates.

2. The [premium] [premium rate schedule] for this policy [will be shown on the schedule page of] [will be attached to] your policy.

3. Rate Schedule Adjustments:

The company will provide a description of when premium rate or rate schedule adjustments will be effective (e.g., next anniversary date, next billing date, etc.) (fill in the blank): __________________.

4. Potential Rate Revisions:

This policy is Guaranteed Renewable. This means that the rates for this product may be increased in the future. Your rates can NOT be increased due to your increasing age or declining health, but your rates may go up based on the experience of all policyholders with a policy similar to yours.

If you receive a premium rate or premium rate schedule increase in the future, you will be notified of the new premium amount and you will be able to exercise at least one of the following options:

• Pay the increased premium and continue your policy in force as is.
• Reduce your policy benefits to a level such that your premiums will not increase. (Subject to state law minimum standards.)
• Exercise your nonforfeiture option if purchased. (This option is available for purchase for an additional premium.)
• Exercise your contingent nonforfeiture rights.* (This option may be available if you do not purchase a separate nonforfeiture option.)

* Contingent Nonforfeiture

If the premium rate for your policy goes up in the future and you didn't buy a nonforfeiture option, you may be eligible for contingent nonforfeiture. Here's how to tell if you are eligible:

You will keep some long-term care insurance coverage, if:

• Your premium after the increase exceeds your original premium by the percentage shown (or more) in the following table; and
• You lapse (not pay more premiums) within 120 days of the increase.

The amount of coverage (i.e., new lifetime maximum benefit amount) you will keep will equal the total amount of premiums you've paid since your policy was first issued. If you have already received benefits under the policy, so that the remaining maximum benefit amount is less than the total amount of premiums you've paid, the amount of coverage will be that remaining amount.

Except for this reduced lifetime maximum benefit amount, all other policy benefits will remain at the levels attained at the time of the lapse and will not increase thereafter.

Should you choose this Contingent Nonforfeiture option, your policy, with this reduced maximum benefit amount, will be considered "paid-up" with no further premiums due.

Example:

"You bought the policy at age 65 and paid the $1,000 annual premium for 10 years, so you have paid a total of $10,000 in premium.

"In the eleventh year, you receive a rate increase of 50%, or $500 for a new annual premium of $1,500, and you decide to lapse the policy (not pay any more premiums).

"Your "paid-up" policy benefits are $10,000 (provided you have a least $10,000 of benefits remaining under your policy.)

 

Contingent Nonforfeiture

Cumulative Premium Increase over Initial Premium

That qualifies for Contingent Nonforfeiture

(Percentage increase is cumulative from date of original issue. It does NOT represent a one-time increase.)

Issue Age Percent Increase Over Initial Premium

29 and under 200%

30-34 190%

35-39 170%

40-44 150%

45-49 130%

50-54 110%

55-59 90%

60 70%

61 66%

62 62%

63 58%

64 54%

65 50%

66 48%

67 46%

68 44%

69 42%

70 40%

71 38%

72 36%

73 34%

74 32%

75 30%

76 28%

77 26%

78 24%

79 22%

80 20%

81 19%

82 18%

83 17%

84 16%

85 15%

86 14%

87 13%

88 12%

89 11%

90 and over 10%