CHAPTER FOUR - BENEFITS

                                           

      As with other types of insurance, when a product is introduced, companies scramble to offer more benefits and still be competitive in premium.  LTCI companies have responded to marketing and consumer interests and have developed the Long Term Care Insurance concept from the original nursing home policy to policies that offer more and more comprehensive benefits.  In order to stay competitive, they are always looking for additional benefits that may not interfere with profit but still offer something that would be attractive to the consumer.  One of the first such benefits was the return-of-premium benefit, which is now offered by all companies in some form or other.  Companies offer medical alert/emergency response systems, ambulance service, etc., which are all interesting and will be attractive to some of the consumers, but really are not that essential to a good insurance plan.  But, as long as companies are required, either by regulation or by competition, to offer basically the same benefits, then enterprising marketers and competitive insurers will continue to “improve” the product, which really is good for the industry and the consumers. 

Alternative Plan of Care

“Alternative care” is care and services that are developed by a licensed health care practitioner for the purpose of providing a less expensive alternative to nursing home care.  The benefits can take the form of special care and treatments, providing care at different sites, modification to one’s home to allow more home health care—building wheelchair ramps, modification to kitchens and bathroom, for instance..

An alternate plan of care must be developed by a health care professional and the insurer must approve such plan. When these benefits are offered, the expenses that are covered under this benefit are usually limited to a percentage of the lifetime benefit or some other criteria.

Shared-Benefit Rider

      A shared-benefit rider allows the duration of the benefit to be lengthened if both spouses have coverage, in effect combining their benefits so if one spouse’s benefits are exhausted, they may “draw” from the benefits of the other spouse.  This Rider may be part of some policies if both spouses have the coverage.  The ability for the spouses to share a “pool” consisting of the combined benefits of the two policies, is less expensive than two separate policies.  This can be a good idea as in so many cases, only one spouse will need long-term care as statistically, the wife usually lives longer than the husband, and she will probably need the long-term care, if for no other reason than her advanced age.  However, if such a plan is offered, the insureds must understand that one spouse can use up all of the benefits, leaving little or nothing for the other spouse.

Bed Reservation Benefit

      This is another benefit offered because of the customer demand.  Once a person is in a Nursing Home for a period of time, it becomes their “home.”  For many elderly persons, it is traumatic if they have to leave the Nursing Home temporarily and then return to another bed. This benefit allows a person to return to his “own bed” after a specified period of time.

      If the insured is hospitalized during a Nursing Home or Assisted Facility stay, and there is a charge for the insured to reserve their bed for a later return, the policy will pay these charges up to a maximum usually of 21 days of hospitalization during a policy year.71

Restoration of Benefit

Most policies do allow for restoration of benefits.  The insured must be off-claim before benefits are restored for periods ranging from 180 days to 6 months as a rule, with most policies using the 180 days.  Most policies have a maximum number of times that they can restore, usually twice.  

The point to remember in discussing restoration of benefits is that the period before benefits are restored must be as indicated (180 days or 6 months usually) in the policy and the insured must have been treatment-free before the claim or the new claim is for a different cause completely.  This can be best explained by example:  The insured had a hip replacement and as a result, he was eligible for 45 days of benefits.  Eight months later he re-injured his hip while working on a home project and went back into the hospital, with several weeks of physical therapy later.  He filed for new benefits, however it was discovered that since his hip surgery he had been taking prescription anti-inflammatories for the pain in his hip.  Therefore he did not qualify for restoration of benefits as he had continued his treatment for the previous injury.

It helps to remember that this provision is required in many states because it was devised to protect elderly insurers who may have forgotten to pay the premium on time.  The insured is still required to pay any back premiums if premiums are in default.

This clause of often confused with the required benefit of "Protection Against Unintentional Lapse," discussed later.

Home Modification and Therapeutic Devices

Sometimes a ramp, lift, handrails, grab bars, wider doors, special bed or other items and devices can increase accessibility and help an individual stay at home and prolong the time before facility care is required. In accordance with the Plan of Care, the company will pay the expenses incurred for pur­chase or rental of supportive equipment. The lifetime maximum for this benefit will vary by company.

A therapeutic device benefit will pay for equipment rented or purchased which is used in the home, which helps keep the insured at home for a longer period, sometimes specifically stated as 90 days, etc.  Typically, the policy will put a maximum lifetime amount on this equipment, typically 50 times the Maximum Daily Benefit, i.e. if the Daily Benefit is $100, the maximum benefit would be $5,000.  This benefit does not affect the Maximum Daily Benefit on any day.  Some policies require that the equipment be part of a formal Plan of Care.

The policy will pay for the purchase or rental of equipment intended to assist the insured in living at home or other residential housing that would otherwise require some direct physical assistance.  This equipment must he reasonably be expected to enable the insured to remain at home for at least 90 days after the equipment has been acquired and it must be part of the formal Plan of Care.  Equipment covered are items such as, but not limited to, pumps and devices for intravenous injection, ramps to allow the insured to move from one level of the residence to another level, support bars in the toiler and bath or shower, and other mechanical aids.  It does not cover any equipment that is installed for the purpose of increasing the value of the residence, or any artificial limbs, teeth or equipment. 

These items are not subject to the Elimination Period, or used to satisfy this period.  The lifetime maximum payment under this provision is typically 50 times the Maximum Daily Benefit, and any payments for this equipment will not count against their Maximum Daily Benefit for any day.

Caregiver Training

Another recent benefit available but not offered by all plans, is the Caregiving Training feature.  Typically, the policy will pay for training of a person to become a Caregiver.  Many policies allow for training for family members.  The payment for training is typically “five times” the Maximum Daily Benefit.

The policy will pay for caregiver training when the caregiver is going to take care of the insured in his home.  They will not pay for training for someone that will be paid to take care of the insured.  If the insured is in a hospital, nursing home, or assisted care facility, they will not pay for this training unless it is reasonably expected that the training will enable the insured to return home where they can be cared for by the person who receives the training. This training does not affect the Elimination Period and cannot be used to satisfy the Elimination Period.  The maximum that the insurer will usually pay is five times the Maximum Daily Benefit.

  (An actual example)— Several years ago, many LTCI policies would pay caregivers provided they were “licensed,” usually as Nursing Assistants or Certified Nursing Assistants.  In Florida there was a group of wealthy widows residing in an area known as the “Gold Coast,” who were bridge players and many had purchased LTCI policies from a local agency.  Just “for something to do,” the ladies decided to see if they could get their insurers to pay for their maids when they discovered that a person could become a licensed caregiver by going to the local community college at night.  So they “cooked up” a scheme— they would go to their doctors, complaining of bad back problems, and insisting that they had to have help in some of their ADLs.  Their doctors were not about to argue with them as who knows whether a person has a bad back or not and they were sources of continual medical fees… When the doctors signed the papers stating that they needed care, the ladies would send their maids—they all had maids—to school to become licensed.  After a short period of time, the maid would return to work full time, the ladies made their claims and the insurer found themselves paying for maids!  The only problem for them was that the same company insured them all.  The company immediately changed the wording in their policies with the approval of the Department of Insurance, and settled with the ladies—but still had to continue paying some of the maids as “caregivers.”

Many policies include an Informal Caregiver Training Benefit. This benefit is payable if a covered person incurs expenses for training an informal caregiver, such as a friend or family member, to care for the covered person at home. The benefit is usually payable without regard to any other benefits and does not reduce the lifetime pool of dollars available for LTC expenses. It is often expressed as a multiple of the daily Nursing Facility benefit amount, such as 5 or 7.

Limited Pay Options

A few policies allow for a paid-up feature, such as single premium plans or those paid up in some specified period of time (3, 5, 10, 20 years typically) or paid up at age 65.  The policy wording may be deceiving as it is possible that after the paid-up period, the insurer can demand additional premiums.  Unless the contract guarantees that the premium will never increase, it is likely that the premiums will be increased and the insured may have to pay additional premium later.

Waiver of Premium

Typically, the insurance company will waive the premiums on the policy and any attached Riders, if the insured is confined to a Nursing Home or Assisted Care facility for a period of more than 90 days.  This waiver applies to premiums falling due thereafter, on the policy and any Riders.  This waiver will continue as long as consecutive days of nursing care benefits are being paid to the insured.

One should carefully check the policy to determine if there are any restrictions on this provision, such as a certain type of care must be received before premiums are waived.

Waiver of premium is usually required, but this is not uniform otherwise.  For instance, some waivers don’t take effect until the first day of the month following the month in which the waiver period was met.  Also some policies only waive premiums when the insured is receiving nursing home care and premiums continue with other care such as home care or an assisted care facility.

Interestingly, Waiver of Premium (WP) provisions, which allow insureds to stop paying premiums while the policy is paying benefits, are completely voluntary and not required or specified in the insurance code that therefore, allows insurers to not offer WP, charge and extra premium for WP, and they can structure them pretty much as they wish.

Some WP provisions have waiting periods but this is rarely seen.

On a study of LTCI policies from the 20 principal LTCI carriers on their most popular plan, it showed that WP is certainly not uniform among plans.  Waiver of Premium was offered at various times:  three after the elimination period; seven after a 90-day continuous confinement; two after a 90-day period of benefits being paid; four on the first day of benefits being paid; two after 180 days after benefits being paid or daily confinement; one after 90 days of either benefits or 90 days of confinement.  One company simply stated “no.”

Non-Forfeiture Benefits

One of the most frequent consumer complaint about LTCI plans was that it wasn’t “fair” that they could pay all this money into the policy and never get any of it back if they do not use the plan benefits.  One cannot compare equally non-forfeiture benefits with life insurance and with LTCI, principally because if a person keeps paying in life insurance, there will be a claim as everyone eventually dies.  However, not everyone requires long-term care, no matter how long they live.  Therefore, the only appropriate method to return some of the premium that has not been paid in claims, to the LTCI insured, is through a “return-of-premium” benefit.  For years, a handful of LTCI plans offered this as a rider at an additional premium (usually quite a substantial premium).  Most companies now offer this as a benefit, but still it can add from 20% to as high as 100% (double the cost of the policy) of the premium. 

With a “return of premium” benefit, the policyholder receives cash, usually a percent of the total premi­ums paid to date after lapse or death.  Another approach is a “shortened benefit period,” where the long-term care coverage continues but the benefit period or duration amount is reduced as specified in the policy.

Relatively new is the “contingent nonforfeiture benefits upon lapse,” a feature that gives policyholders additional options in the face of a significant increase in policy premiums.  If the insured does not purchase the optional nonforfeiture benefit, then a contingent nonforfeiture benefit is triggered if policy premiums rise by a specified percentage.

Typically, this option provides for a percentage refund of the total premiums paid less any benefits paid or payable, should one die or terminate this coverage.  Usually this is allowed only on non-tax qualified policies (tax qualified and non-tax qualified discussed later).  In California, cash back, extended term, and reduced paid-up forms of nonforfeiture benefits are not allowed.72  Further, any refund on a complete surrender or cancellation of the contract shall be includible in gross income to the extent that any deduction or exclusion is allowable with respect to the premiums.  Each company has its own version of Return of Premium benefit and agents must be careful to see that premium dollars are not spent on these provisions until adequate types and limits of coverage have been purchased.

With this rider, after a specified number of years, insureds can drop the policy altogether and receive some or all of their premiums back.  It has been argued that this allows people to hedge their bets by buying the insurance coverage and then getting their money back if long-term care isn’t necessary.  This argument is specious, however, as the insured does not get ALL of his money back, plus the fact that these riders are expensive and (during times of “normal” investment income) many could earn more by investing the extra money that they paid for the rider instead.

It behooves the professional agent to explain the relationship between the benefit and the cost and exactly how it applies to their situation.  The return of premium benefit would probably be more attractive and would be more reasonable for younger (age 50-60) applicants.  It should be discussed that the Non-forfeiture/Return of Premium is something they can probably do without, particularly since it usually increases their premium significantly, with very little in return.

All things being equal, the extra premium would be better spent on purchasing more comprehensive coverage, such higher daily benefit, longer benefit period, or shorter elimination period.

Shortened Benefit Period

Actually another form of a nonforfeiture provision, the shortened benefit period, provides a mechanism whereby all of the money put into a policy cannot be lost if the policyowner stops paying premiums at some future date.  Since both federal and California laws require that a nonforfeiture provision must be offered to every prospective policyowner, his may be more attractive that the return-of-premium.

California Insurance Code states: “No insurer may deliver or issue for delivery a long-term care policy in this state unless the insurer offers at the time of application an option to purchase a shortened benefit period nonforfeiture benefit with the following features:

  • Eligibility begins no later than after 10 years of premium payments.
  • The lifetime maximum benefit is no less than the dollar equivalent of three months of care at the nursing facility per diem benefit contained in the policy or the amount of the premiums paid, whichever is greater.
  • The same benefits covered in the policy and any riders at the time eligibility begins are payable for a qualifying claim.
  • The lifetime maximum benefit may be reduced by the amount of any claims already paid.
  • Cash back, extended term, and reduced paid-up forms of nonforfeiture benefits shall not be allowed.
  • The lifetime maximum benefit amount increases proportionally with the number of years of premium payment.

This section shall not apply to life insurance policies that accelerate benefits for long-term care.”73

REQUIRED BENEFITS

30-Day Free Look

"Applicant has the right to inspect the policy and, if not satisfied for any reason whatsoever, to return the policy directly to the insurer for a refund of all money paid.  Agents are forbidden to harass or otherwise try to pressure their clients into keeping the policy in force.

An applicant for a long-term care insurance policy or a certificate, other than an applicant for a certificate issued under a group long-term care insurance policy issued to a group …(as described in another Section of the Code)… shall have the right to return the policy or certificate by first-class United States mail within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason.  …The return of a policy or certificate shall void the policy or certificate from the beginning and the parties shall be in the same position as if no policy, certificate, or contract had been issued. All premiums paid and any policy fee paid for the policy shall be fully refunded directly to the applicant by the insurer within 30 days after the policy or certificate is returned.  …Notwithstanding Section 10276 or any other law, long-term care insurance policies or certificates to which this section applies shall have a notice prominently printed on the first page of the policy or certificate, or attached thereto, stating in substance the conditions described in subdivisions…(above)."74

Protection against Unintended Lapse

The possibility exists that an insured may become mentally impaired and forget to make premium payments. This could result in the unintentional lapse of a long-term care insurance policy just at the time when its benefits are needed most.  To prevent this from happening, with both qualified and nonqualified policies, the insurer is required to offer a policy provision to protect against unintentional lapse.

  • Ability to add a designated Person to receive a notice if the premium is not paid and the policy is in danger of lapsing.
  • Reinstatement for lapse due to cognitive or physical impairment if requested up to 5 months after lapse.
  • Ability to step-down in coverage and keep policy in force.

Note, however, that when premiums are paid on a bank-draft basis, this takes care of the majority of these unintended lapses as it takes an intended effort to stop the insurance premiums.

Authorized Designee Statement & Waiver

The policyowner must designate at least one individual other than himself or herself who will receive notification should the policy be in danger of lapsing.  The insurer is required to notify such individual at least 30 days before a lapse becomes effective.  The policyowner may change the designation no less often than once every two years.

Prospective policyowners who do not wish to include this provision in their long-term care policy must sign a written waiver worded as follows:

“I understand that I have the right to designate at least one person other than myself to receive notice of lapse or termination of this long-term care insurance policy for nonpayment of premium. I understand that notice will not be given until 30 days after a premium is due and unpaid. I elect not to designate any person to receive the notice.

Signature of Applicant ___________________________     Date____________________

Unintentional Lapse of Policy - Reinstatement

"If, despite this precaution, the policy does lapse, the provision allows reinstatement of the policy if it can be demonstrated that the lapse was due to cognitive impairment or loss of functional capacity, no more than five months have passed since the policy was terminated and the past due premiums are paid."75

Renewability Provision

"All individual long-term care insurance policies must contain a renewability provision. This provision must be appro­priately captioned, appear on the first page of the policy, and clearly disclose the term of coverage for which the policy is initially issued, the terms and conditions under which the policy may be renewed, and whether or not the issuer has the right to change the premium. If this right exists, the policy provisions will clearly and concisely describe each circumstance under which the premium may change. Every individual policy must be either guaran­teed renewable or noncancelable.

After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the insured, unless the increased benefits or coverage are required by law. If a separate additional premium is charged for benefits provided in connection with riders or endorsements, that premium charge shall be set forth in the policy, rider, or endorsement.  …If a long-term care insurance policy or certifi­cate contains any limitations with respect to preexisting conditions, those limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as “preexisting condition limita­tions.”  …A long-term care insurance policy or certificate containing any limitations or conditions for eligibility shall set forth in a separate paragraph of the policy or certificate a description of those limita­tions or conditions, including any required number of days of confinement, and shall label that para­graph 'Limitations or Conditions on Eligibility for Benefits.' "237

Guaranteed Renewable or Noncancelable

"     Every individual and group long-term care policy and certificate under a group long-term care policy shall be either guaranteed renewable or noncancelable.

Guaranteed Renewable

'Guaranteed renewable' means that the insured has the right to continue coverage in force if premiums are timely paid during which period the insurer may not unilaterally change the terms of coverage or decline to renew, except that the insurer may, in accordance with provisions in the policy, (according to the Insurance Code)… change the premium rates to all insureds in the same class. The 'class' is determined by the insurer for the purpose of setting rates at the time the policy is issued." "Every long-term care policy and certificate shall contain an appropriately captioned renewability provision on page one, which shall clearly describe the initial term of coverage, the conditions for renewal, and, if guaranteed renewable, a description of the class and of each circumstance under which the insurer may change the premium amount."249

In California, all LTC policies are required to be at least guaranteed renewable with a level premium which takes into account all of the anticipated increases in premium over the lifetime of a policyholder or over the entire term of the policy.

Rates can only be increased for an entire class of insureds and only upon statistical review and ap­proval of the requested rate increase by the Department of Insurance. No single policy can be experi­ence rated, canceled or non-renewed.

Noncancelable

'Noncancelable' means the insured has the right to continue the coverage in force if premiums are timely paid during which period the insurer may not unilaterally change the terms of coverage, decline to renew, or change the premium rate.  …Every long-term care policy and certificate shall contain an appropriately captioned renewability provision on page one, which shall clearly describe the initial term of coverage, the conditions for renewal, and, if guaranteed renewable, a description of the class and of each circumstance under which the insurer may change the premium amount.

Riders or Endorsements Requires Signed Acceptance

Except for riders or endorsements in response to a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal shall require signed accep­tance by the insured."76

Upgrading - Step-Up In Coverage Provisions

Every policyholder is entitled to choose, at least once every year, to increase coverage by paying an additional premium for riders that:

  • Increase the amount of the per diem benefits;
  • Increase the lifetime maximum benefit; and
  • Increase the amount of the nursing home per diem benefit and the home and community-based care benefits of a comprehensive LTC policy.

The premiums for the additional riders can be based on the insured’s attained age at the time of the additions. Since the riders provide additional coverage, the insurer may require the insured to undergo new underwriting before issuing the riders.

The insurer may restrict the age for issuance of additional coverage and restrict the aggregate amount of additional coverage an insured may acquire to the maximum age and coverage the insurer allows when issuing a new policy or certificate.77

Downgrading - Option to Lower Premium (Amended 1999 - SB 870)

Every policy or certificate shall include a provision that gives the policyholder or certificate holder the right to reduce coverage and lower premiums.  This right, exercisable any time after the first year, to retain a policy or certificate while lowering the premium in no fewer than the following three ways:

  •    Reducing the lifetime maximum benefit.
  • Reducing the nursing facility per diem and reducing the home-and community-based service benefits of a home care-only policy and of a comprehensive long-term care policy.
  • Converting a “comprehensive long-term care” policy or certificate to a “Nursing Facility Only” or a “Home Care Only” policy or certificate, if the insurer issues those policies or certificates for sale in the state.

"In the event of a premium increase, the insured shall be offered the option to lower premiums and reduce coverage. The premium for the policy or certificate that is reduced in coverage will be based on the age of the insured at issue age and the premium rate applicable to the amount of reduced coverage at the original issue date.

If the contract in force at the time a reduction in coverage is made provides for benefit adjustments for anticipated increases in the costs of long-term care services, then the reduced nursing facility per diem, lifetime maximum benefit, and daily, weekly, or monthly home care benefits shall be adjusted in the same manner and in the same amount as the contract in force prior to the reduction in coverage.

In the event a policy or certificate is about to lapse, the insurer shall provide written notice to the insured of the options to lower the premium by reducing coverage and of the premiums applicable to the reduced coverage options. The insurer may include in the notice additional options to those above. The notice shall provide the insured at least 30 days in which to elect to reduce coverage and the policy shall be reinstated without underwriting if the insured elects the reduced coverage."78

Updating Existing Coverage (Amended 1999 - SB 870)

"Every policy shall contain a provision that, in the event the insurer develops new benefits or benefit eligibility or new policies with new benefits or benefit eligibility not included in the previously issued policy, the insurer will grant current holders of its policies who are not in benefit or within the elimination period the following rights:

  • The policyholder will be notified of the availability of the new benefits or benefit eligibility or, new policy within 12 months. The insurer’s notice shall be filed with the Department at the same time as the new policy or rider.
  • The insurer shall offer the policyholder new benefits or benefit eligibility in one of the following ways:
    • By adding a rider to the existing policy and paying a separate premium for the new benefit or benefit eligibility based on the insured’s attained age. The premium for the existing policy will remain unchanged based on the insured’s age at issuance.
    • By replacing the existing policy or certificate in accordance with CIC Section 10234.87.
    • By replacing the existing policy or certificate with a new policy or certificate in which case consideration for past insured status shall be recognized by setting the premium for the replacement policy or certificate at the issue age of the policy or certificate being replaced.

The insured may be required to undergo new underwriting, but the underwriting can be no more restric­tive than if the policyholder or certificate holder were applying for a new policy or certificate.  Further, the insurer of a group policy must offer the group policyholder the opportunity to have the new benefits and provisions extended to existing certificate holders, but the insurer is relieved of the obligations imposed by this section if the holder of the group policy declines the issuer’s offer. This section shall become operative on June 30, 2003."79

Future Government Long-Term Care Program

"In the event a non-Medicaid national or state long-term care program is created through public funding that substantially duplicates benefits covered by the policy or certificate, the policyholder or certificate holder will be entitled to select either a reduction in future premiums or an increase in future benefits. An actuarial method for determining the premium reductions and increases in future benefits will be mutually agreed upon by the Department and insurers. The amount of the premium reductions and future benefit increases to be made by each insurer will be based on the extent of the duplication of covered benefits, the amount of past premium payments, and claims experience. Each insurer’s premium reduction and benefit increase plans shall be filed and approved by the Department."80

EXCLUSIONS AND LIMITATIONS

"A long-term care insurance policy or certificate containing any limitations or conditions for eligibility shall set forth in a separate paragraph of the policy or certificate a description of those limitations or conditions, including any required number of days of confinement, and shall label that paragraph “limitations or conditions on eligibility for benefits."

Permitted Exclusions and Limitations (As Amended 1999 - SB 870)

California allows only certain limitations and Exclusions and there is no requirement that they all must be included in their policies, but no other exclusion is allowed in LTCI policies.

The Code instructs that there shall be no policy delivered or issued for delivery in this state as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident, except as to the following:

  •    Preexisting conditions or diseases.
  • Alcoholism and drug addiction.
  • Illness, treatment, or a medical condition arising out of any of the following:
  • War or act of war, whether declared or undeclared.
  • Participation in a felony, riot, or insurrection.
  • Service in the armed forces or units auxiliary thereto.
  • Suicide, whether sane or insane, attempted suicide, or intentionally self-inflicted injury.
  •    Aviation in the capacity of a non-fare-paying passenger.
  •    Treatment provided in a government facility, unless otherwise required by law, services for which benefits are available under Medicare or other governmental programs (except Medi­-Cal or Medicaid), any state or federal workers’ compensation, employer’s liability or occupa­tional disease law, or any motor vehicle no fault law, services provided by a member of the covered person’s immediate family, and services for which no charge is normally made in the absence of insurance.

This section does not prohibit exclusions and limitations by type of provider or territorial limitations.

PRE-EXISTING CONDITIONS

If a long-term care insurance policy or certificate contains any limitations with respect to pre-existing conditions, those limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as “pre-existing condition limitations.”

Definition of Preexisting Condition (Amended By SB 870)

"No long-term care insurance policy or certificate, other than a group policy or certificate, shall use a definition of preexisting condition which is more restrictive than a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person.

Every long-term care insurance policy or certificate shall cover preexisting conditions that are dis­closed on the application no later than six months following the effective date of the coverage of an insured, regardless of the date the loss or confinement begins.

The definition of preexisting condition does not prohibit an insurer from using an application form de­signed to elicit the complete health history of an applicant, and on the basis of the answers on that application, from underwriting in accordance with that insurer’s established underwriting standards. Unless otherwise provided in the policy or certificate a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period expires.

Unless the Commissioner has specifically approved a waiver or rider, no long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit, or reduce cover­age or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period."81

PROHIBITED PROVISIONS IN CALIFORNIA LTC POLICIES

The LTCI policies in California are provided with certain protections under the insurance code.  The following provisions indicate what are NOT allowed in any LTCI policy issued or delivered in the state.

No Termination of Coverage During Claim

"Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if that institutionalization began while the long-term care insurance was in force and continues without interruption after termination. This extension of benefits beyond the period the long-term care insurance was in force may be limited to the duration of the benefit period, if any, or to payment of the maximum benefits and may be subject to any policy waiting period, and all other appli­cable provisions of the policy.

Even though the benefits must be continued during a claim, if the insured stopped paying the premiums and a policy was terminated, if they were to recover and, at a later date, filed a new claim, their policy would not be available if terminated due to non-payment of the premium. The better option is to add a waiver of premium rider to the LTCI policy, which allows an individual to stop paying premiums during the time one is receiving benefits but the policy remains in full force. A company will waive premium payments on a month-to-month basis during extended nursing home and other facility stays and some contracts also waive premium when the insured is receiving home care benefits. If the insured recovers, they must begin to pay premiums again to keep the coverage in force but are not responsible to repay any of the premiums paid under the WP rider. This benefit is not required under current California insurance law and is available at the sole discretion of the individual company."82

Health & Safety Code

"No long-term care policy or certificate that is issued, amended, renewed, or delivered on and after January 1, 2002, shall contain a provision that prohibits or restricts any health facilities’ com­pliance with the requirements of Section 1262.5 of the Health and Safety Code."83.

No Prior Hospital Stay Requirement

On or after January 1, 1990, no long-term care insurance policy may not be delivered or issued for delivery in this state which does any of the following:

  • Preconditions the availability of benefits on prior hospitalization.
  • Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care.
  • Preconditions the availability of benefits for community-based care, home health care, or home care on prior institutionalization.
  • Conditions eligibility for non-institutional benefits on a prior institutional stay of more than 30 days.
Discrimination Based on Individual’s Health

"Policies may not contain a provision that would cancel, non-renew or otherwise terminate the coverage based on the insured’s age or the deterioration of the insured’s mental or physical health."84

“Usual and Customary” Standard Prohibited

"Policies may not contain a provision that bases payment of benefits on any standard described as “usual and customary,” “reasonable and customary” or other similar words."85

Termination Due To a Divorce Prohibited

"Policies may not contain a provision that terminates a policy, certificate, or rider, or allows the premium for an in-force policy, certificate, or rider, to be increased due to the divorce of a policyholder or certifi­cate holder."86 

No Preference for Skilled Care

"Policies may not contain a provision for coverage for skilled nursing care only or a provision for signifi­cantly more coverage for skilled care in a facility than coverage for lower levels of care.

Policies may not contain a provision that limits or denies benefits to policyowners who are diagnosed with Alzheimer’s disease or other similar degenerative illnesses of the brain."87

New Waiting Periods after Conversion or Replacement

"Policies may not contain a provision that would establish a new waiting period, probationary period or pre-existing conditions in the event existing coverage is converted to or replaced by a new or different policy with the same insurer (except in cases where the insured voluntarily selects an increase in benefits)."88 

No New Preexisting Conditions on Replacement Policies

"If a long-term care policy of certificate replaces another, the replacing insurer must waive any time period applicable to preexisting conditions and probationary periods to the extent that similar exclu­sions have been satisfied under the original policy or certificate."89 

Reduction of Benefits Due to Out-of-Pocket Expenditures

"LTC policies may not contain a provision that would reduce insurance benefits because of out-of-pocket expenditures by the insured or by another individual on behalf of the insured. That is, policyowners may not be subjected to any form of “means test."90

Value of All Benefits Must Be Disclosed

Policies may not contain a provision that includes an additional benefit for a service with a known market value other than the statutorily required home- and community-based service benefits, the assisted living benefit, or a nursing facility benefit, unless the additional benefit provides for the pay­ment of at least five times the daily benefit and the dollar value of the additional benefit is disclosed in the schedule page of the policy.

INFLATION PROTECTION

When LTCI policies were first introduced (originally “Nursing Home Policies”) it soon became apparent that the element of inflation was not addressed.  When it came time to determine a daily benefit, it usually was determined by the cost of nursing home care.  Since all costs were increasing, it was obvious that LTCI policies must be able to keep abreast of the increase in long-term care.  The problem was addressed by increasing the daily benefit to reflect the increase in cost, usually by offering a Rider that increased the daily benefit by a percentage each year—5% seems to be the approved standard—either on a simple-interest basis or on a compounded interest basis.  On a simple-interest basis, if the daily benefit were $100, then the daily benefit would increase 5% ($5) each year.  On the compound basis, the second year the daily benefit would be $105, the next year the increase would be 5% of $110.25, then $115.76, etc.  For instance, 5% simple on a $100 daily benefit adds $5 per year. In 10 years the simple increase has increased $100 to $150.  In 20 years, $100 becomes $200.  On the other hand, 5% compound has increased $100 to $163 in 10 years and to $265 in 20 years.

Compounding increases will double the benefit amount approximately every 15 years while simple increases take about 20 years to double.                                                                                                     .

The cost of the Rider is more expensive with the compound method as the daily benefit increases faster.  Since most policyholders will not need long-term care benefits in the early years of coverage, they will be more likely to need it in 15 to 20 years, hence the inflation protection.  Conversely, at a steady annual inflation rate of 5%, $100 today would only be worth $38 in today’s dollars, 20 years from now.

Protecting benefits against the ravages of inflation is a very important decision, and as such, California and most other states following the NAIC Model Act, automatically offer inflation protection in one form or another.  Protecting a policyholder’s benefits against inflation is one of the most important decisions they can make when purchasing a long-

 

 

 

 

 

 

term care insurance policy.  But, it is expensive, relatively speaking, when compared to the premium for the base policy.  The principal reason, overwhelmingly, that an inflation protection is declined, is because of cost.  All that can be done, really, is to fully explain the problems of inflation and the consequences of refusing the coverage. NOTE:  Graph illustrating annual costs of NH care with inflation of 5% in Summary Chapter.246

Cost of Nursing Home Care in California & by Area

The average cost of NH care in California in 2004 was $165 per day.

Rank                                       Area                                        Av. Annual Cost (rounded)……..

16                                San Francisco Bay Area                                  $67,100

21                                San Diego County                                          $62,900

28                    North California, outside SF Bay area                       $60,500

31                    South California, exclude LA & San Diego   $58,300

43                                Central California                                           $53,700

47                                Los Angeles County                                       $52,500

Life Expectancy & the Need for Inflation Protection

The following chart indicates the life expectancy as of 1998 (mortality changes since then are miniscule) at ages 50-80 in 5 year increments and an estimate of the annual cost of long-term care in 2004 with a 5% annual inflation.91 

AGE                           LIFE EXPECTANCY                                 ANNUAL COST OF LTC

50                                            36 years to age 86                                           $295,961

55                                            31 years to age 86                                           $231,893

60                                            27 years to age 87                                           $190,779

65                                            23 years to age 88                                           $156.594

70                                            19 years to age 89                                           $129,127

75                                            15 years to age 90                                           $106,233

80                                            12 years to age 92                                           $  91,786

(California statistics 1998—Note reference 96)

These statistics are interesting as it shows that even at advanced ages, the life expectancy is such that there can be considerable increases in long-term care costs because of inflation. Still, at age 70, an average female has about 20 years of life remaining & @ 5% increase, her LTC costs would triple. Without inflation protection, she may have either spend down her assets or she may discover that she cannot afford the standard of care that she would like (or both).  With the protection, she would pay the same premium during this period, but her benefits would triple. Also, if she qualified for LTCI, she is "select" for underwriting & longevity purposes, meaning she should live longer than the average!

Future Nursing Home Costs

People live longer today—a person age 65 can see 25 or more years ahead of him, which is good news, but with 25 or more years of inflation, the bad news.  Mortality studies show that just before WWII, only 7% of 65-year olds could expect to see their 90th Birthday, in 1960 it had increased to 14%, 25% in 1980, but today, a 65-year old has almost a 50% chance of seeing their 90th birthday.92   Taking this a step further, a 65-year old has better than a 60% chance of reaching age 85, nearly 45% chance of reaching 90, and even almost 10% chance of celebrating a 100th birthday.93 

Another aspect of the LTC problem is the fact that costs for all forms of health care have been continu­ally rising, and frequently rising at a more rapid pace than general increases in overall consumer prices. Costs for nursing care, and all other forms of long-term care, are expected to continue to rise.

By 2030, total national expenditures for home- and community-based long-term care will more than quadruple, from $41 billion today to $193 billion. Total national expenditures for nursing home care could reach $330 billion - equal to today’s entire Social Security budget. This illustrates the impor­tance of taking personal responsibility for their financial future and for future long-term care needs.

Inflation - Other Types of Care
  •   Adult day care, which currently costs an average of $50 per day (or $12,981 per year), will increase to $220 per day (or $56,100 per year);
  • Assistance by a home health aide, which now costs $61 per visit (or $15,743 per year at five visits per week), will cost $260 per visit (or $68,000 per year);
  •   Staying in an assisted living-facility, which currently averages $25,300 per year, will cost $109,300 per year, and
  •   Nursing home care, which now averages $44,100 per year, will cost $190,600 per year.94

Anticipated Increase in Annual Nursing Facility Care95

Year

5% Compound Inflation

 

1998

  $46,525

1999

  $48,850

2000

  $51,300

2005

  $65,466

2010

  $83,555

2015

$106,640

2020

$136,100

Increase in Nursing Home Rates vs. Consumer Price Index

The increase in long-term care costs generally surpasses the increase in the Consumer Price Index. At even a modest rate of inflation, nursing home care costs could reach $200,000 a year or more over the next 30 years. Since many retirees are on a fixed income, that type of added expense would create a difficult financial burden.

Between 1985 and 1995, nursing home prices increased by an average of 9.7 percent.  In 1995, for example, the Consumer Price Index (CPI) rose only 2.8 percent while nursing home rates increased 8 percent.

The increase in nursing home care costs has almost always surpassed the increase in the Consumer Price Index indicating that nursing home care costs are going up at a greater rate than the general costs of living. Even at a modest rate of inflation, the cost of nursing home care is likely to become more and more expensive as time goes along. For people on a fixed income, as are many retirees, this rise in cost should be of special concern.96

Year

Percentage Increase

California Nursing

Facility Private Rate

Consumer

Price

Index

1980

12.1%

12.5%

1985

7.0%

3.8%

1990

6.6%

6.1

1991

5.5%

2.7%

1995

5.1%

2.5%

1996

4.8%

3.3%

The average cost of care in California increased 6.7% annually.  The Consumer Price Index aver­aged only a 4.4% increase.

As a point of interest, in the same vein, according to the Centers for Medicare and Medicaid Services, nursing home care was $98.9 billion in 2001, an increase of 5 ½ percent from the previous year.  Since 1980 Medicare nursing home expenditures have grown from $307 million to $9.6 billion, a growth rate of 3022%, an average annual rate of 30%.

Types of Inflation Protection

Automatic Inflation Protection

Automatic Inflation Protection increases the daily benefit annually on the policy’s anniversary automatically.  The amount of increase is usually based on a predetermined rate—typically 5 percent per annum.

With the automatic protection, the cost of the automatic increase riders is part of the policy’s original premium, so, as in most insurance plans, the insureds are pre­paying for future benefits.  The annual premium that includes an automatic benefit increase rider is be more expensive at the inception, than the other methods wherein the protection is afforded through a Rider or Amendment, but it is considered as the least expensive overall.

Option to Purchase Inflation Protection

Inflation protection may be offered as an option in some plans, whereby the insured may buy additional daily benefit coverage at predetermined and periodic intervals without having to reapply and without evidence of insurability.  Typically, the plans offer a 15% increase every 3 years.  The premium for accepting the option is calculated at the attained age rate, and added to the premium, therefore when the option is elected, the premium increases.  While this system may be attractive in the early years because the entry premium is lower than with the automatic protection, in most cases it really is not the best way to obtain inflation protection.

Unfortunately, most people that have the option available, do not take advantage of it for a variety of reasons, usually they forget and do not choose to elect the increases.  Practically, when the insured purchases a LTCI policy, the details as to why it is necessary and why it is necessary to offset the effects of inflation on the daily benefit if fresh on their mind.  Three years later, it does not seem like “such a big deal” and many have a tendency to forget about why they should increase their premium.

Another problem is that if they do not elect to accept the options, of a specified number of options, then this feature will be rescinded.  The reason that the insurers rescind the option is because of anti-selection—if a person does not elect to increase the benefits for several option periods, and then all-of-a-sudden decides that they really, really need this feature, the message sent to the insurer is that the insured is expecting to use the policy so a one-time increase in premium that would increase the benefit, probably very soon, is attractive to the insured.  The option does not require underwriting, so this anti-selection could be a real problem, ergo, the rescinding of the option.

The end result is that individuals with this kind of inflation protection usually do not have adequate protection when they’re older.  Furthermore, if they do elect the increases, they will pay as much as twice as much over the life of the policy that if they had elected the automatic protection.  Of course it depends upon how long the insured lives without receiving benefits and the premiums charged.  LTCI premium vary greatly by company and by plan, but in order to show the difference, actual premiums with the automatic protection should be compared with the premiums without the automatic protection, but with the 3-year option.  At the end of the 3-year period, add the additional premium, do the same at the end of each option period.  By the end of 20 years, compare the premium, do a little arithmetic and it will be discovered that the insured paid considerable more for the option plan.  Why?  Technically, the additional premium for the automatic protection is “reserved” and allowed to grow at interest.  Therefore, because of the magic of compounding, there are sufficient funds to pay the increased benefit.  Conversely, the insurer must not only collect for the premium for the increase in benefits but then they do not have the value of the invested funds to compensate for the benefit increase—therefore the premium must be higher.  For those on fixed incomes, paying for the increase is part of the premium, so they will not have to face increasing premiums, even though their coverage increases.  This is a win-win situation.

Increase in Premium for Inflation Protection

An illustration provided by a large participant in the Partnership program, shows that at age 70 (usually used in LTCI illustrations) the annual premium for a nursing home benefit of $100 a day, with a 90-day elimination period and 4-year benefit, with no inflation protection, is $1,428.50.  With a 5% compound inflation protection, the premium is $2,339.30 (61% higher).

When home care is added at 80% of the nursing home benefit, the premium is $1,782.00.

Adding inflation protection to the plan with home care, it now is $2,917 (61% higher).

In checking with other companies, the normal increase is closer to 50-55% when inflation protection is added.  Interestingly, these are large, well-known companies, and the company with the 61% increase traditionally competes with another company of the same type, size, etc., who offers the automatic inflation protection with an increase of only 51% in premium. 

Consumer Reports, 1997, strongly suggests that no one purchases an LTCI policy unless they also have inflation protection & their premium increases projected follows the above percentages,(even though they are 7 years old).

 

Statutory Requirements - Mandatory Offer of Inflation Protection

Insurers must offer to each policyowner, at the time of purchase, (or to the group policyowner) the option to purchase a long-term care insurance policy containing an inflation protection feature that is no less favorable than one that does one or more of the following:

  • Increases benefit levels annually in a manner so that the increases are compounded annu­ally at a rate of not less than 5.percent.97
  • Guarantees the insured individual the right to periodically increase benefit levels without providing evidence of insurability of health status so long as the option for the previous period has not been declined. The amount of the additional benefit shall be no less than the differ­ence between the existing policy benefit and that benefit compounded annually at a rate of at least 5 percent for the period beginning with the purchase of the existing benefit and extend­ing until the year in which the offer is made.98
  • Covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount limit.
Insurer Must Provide 5% Compounded Unless Rejected

Unless an insurer obtains a rejection of inflation protection signed by the policyholder, an inflation protection provision that increases benefit levels compounded annually at a rate not less than 5 per­cent must be included in a long-term care insurance policy.99

Written Rejection of Inflation Protection

The rejection, to be included in the application or on a separate form, shall state:

I have reviewed the Outline Of Coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection.  Specially, I have reviewed the plan, and I reject inflation protection.

Signature of Applicant:____________________________________________                 

Date Mandated Offer for Group Coverage:___________________________

When the policy is issued to a group, the offer to increase benefits and protect against inflation is made to the group policyholder.  However, if the group policyholder is not an employer, professional, trade or other such association, the insurer must tender the offer to each proposed certificate holder.  But if the offer is declined by the group policyholder, the offer will be made to each certificate holder.247

Clients who buy long-term care insurance through a group, like an employer, or an association may not be able to purchase the option if the group master policyholder didn’t choose to offer it to their mem­bers. 100

Exceptions to Mandated Offer

The offer is not required of any of the following:                                                        .

  • Life insurance policies or riders containing accelerated long-term care benefits
  •    Expense incurred long-term care insurance policies.  For these purposes “expense incurred” does not include policies paying a certain percentage of reasonable and customary charges up to a specified, indemnity-type maximum amount.
Level Premiums

An offer of inflation protection that provides for automatic benefit increases must include an offer of a premium that the insurer expects to remain constant.  The offer must disclose in

 

a conspicuous man­ner that the premium may change in the future unless the premium is guaranteed to remain constant.

Each year, the insured will receive a notice from the insurer showing the new amounts of their cover­age similar to the statement they receive from their bank showing the growth of their savings account.  Most people expect that whenever coverage on an insurance policy increases, they will experience a rate increase.  Policyholders are delighted, even amazed, to find that the coverage on their Partnership policies increases year after year, but the premium remains the same.

The daily, weekly and lifetime benefit amount increase on each anniversary of the policy’s effective date just like the way money grows in a savings account.  The benefit increases will occur on each policy anniversary date for the lifetime of the policy, even when the insured is receiving benefits.101

Prohibited Limits on Inflation Protection

Inflation protection benefit increases must continue without regard to an insured’s age, claim status or claim history, or the length of time the person has been insured under the policy.102

No Reduction of Inflation Benefit Increase Due To Payment of Claims

The inflation protection benefit increases under a policy or certificate that contains an inflation protection feature shall not be reduced due to the payment of claims.

Inflation Protection per SB 870

Year

Daily

Benefit Benefit

Monthly

Maximum

Lifetime

1998

$127

           $3876

$46,515

1999

134

4071

48,850

2000

141

4275

51,300

2001

148

4489

53,865

2005

179

5456

65,466

Prior to SB 870, some insurers deducted the amount paid in claims from the “pool of dollars” before applying the inflation percentage. Even though this didn’t affect the increase in the daily or monthly benefits, it resulted in a much lower total lifetime maximum than insurers who credited the inflation percentage to the original coverage amount. This meant the benefits would run out sooner. SB 870 made it mandatory that all insurers increase the lifetime maxi­mum without regard to the amount of claims paid.103

Outline of Coverage Must Include Inflation Information

California law requires that the agent during an LTCI sales process must explain the inflation charts as required by the law and included in the Outline Of Coverage—which must be provided to the client with the application.  Part of the agent’s responsibility during the sales process is to carefully explain the inflation charts that are required by California Law and included in the Outline Of Coverage which must be provided to the client with the application.  Agents must always explain the inflation protection benefits fully and completely as required by the insurance code.

In addition to this code requirement, there is a risk of personal liability for agents who market LTCI policies without inflation protection or with inadequate inflation protection.  Therefore, it behooves all LTCI Agents to carefully and fully document all sales activities in this respect.

In order to best and to fully information the application of the inflation protection feature available with the LTCI policy, and the costs thereof, the Outline Of Coverage must include a graphic comparison of the benefit levels of a policy that increases benefits at a compounded annual rate of at least 5 percent over the policy term with a policy that does not increase benefits.  This comparison must show benefit levels over a period of at least 20 years.104

An Alternate to Inflation Protection

A question that is often raised, particularly by the more astute applicant, is why not just purchase a higher daily benefit rather than the (expensive) inflation protection?  This has been called the “Short-Fat” concept as the insured has a high benefit limit but has a shorter benefit period.  Most argue that it is better to purchase shorter coverage with inflation protection than longer coverage without inflation coverage. Under the pool-of-dollars concept the insured does not have to use the total amount of the benefit that is available. Whatever is not used will remain available for use later and will make coverage last longer.  This will result in adequate coverage even during periods of high inflation but coverage can be stretched out by not using the entire benefit available per day or month if less will cover the insured’s costs.  One should be aware that regardless of the pool amount, the policy would have a maximum daily benefit. 

Assume a 4-year policy with $100 daily benefit, the premiums of which would approximate a 2-year policy with $200 daily benefit.  In this case, the 2-year policy would be better because of the maximum daily benefit restriction and because of the “pool” concept, funds can be used to pay for lesser expensive long-term care if needed.  The policyholder would have more flexibility in using the benefits for his needs.  If the cost of the nursing home facility were $180 per day, the insured would have to come up with the difference ($80) under the plan with $100 daily benefit, so he would be spending assets that he does not want to spend.  Under the 2-year plan he would have full coverage and a longer period of time in which to spend the “pool” funds.  When his pool amount was spent, then he could transfer to Medi-Cal.  (See discussion of Partnership Plans.)

Is Inflation Protection Worth The Cost?

Many consumers should never purchase a policy without inflation pro­tection, says Consumer Reports.  5% compound inflation protection increases the premium an average of 70% for 65-year olds and an average of 60% for 70 year olds. 5% simple inflation protection increases the rates for 70 year olds by about 50%—but it is well worth the added expense and the client will recoup the entire added premium within the first 3-6 months on benefit. (These percentages closely follow those examples previously discussed.)

Even though customers will have to make some compromises, such as longer elimination periods, shorter benefit periods or fewer “frills,” they suggest that no policy be purchased without inflation pro­tection of at least 5% compounded. This is a pretty hefty recommendation from a magazine that is usually reluctant to recommend anything more than a “bare bones” approach to buying insurance.


 

STUDY QUESTIONS

 

1.  Care and services that are developed by a licensed health care practitioner for the purpose of providing a less expensive alternative to nursing home care is called

      A.  Alternative Plan of Care.

      B.  Expanded Nursing/Custodial Care.

      C.  Care Assessment.

      D.  Medi-Cal.

 

2.  If a policy has a Restoration of Benefit rider, in order to receive these benefits the insured must be

      A.  off-claim for periods ranging from 180 days to 6 month.

      B.  a patient in any nursing facility.

      C.  a policyholder for over 3 years.

      D.  confined in a nursing home or hospital for at least 90 days.

 

3.  Typically, the premium on an LTCI policy will be waived if

      A.  the insured has been receiving any benefit under the LTCI policy for 90+ days.

      B.  both spouses are insured under the same policy with the same company and are claimants.

      C.  the insured is confined to a nursing home or assisted care facility for more than 90 days.

      D.  the insured has not had a claim for 75% of the benefit period.

 

4.  A benefit required in all LTCI policies sold in California (and all other states) is

      A.  a Waiver of Premium payable after receiving any policy benefits for 90 days or more.

      B.  a 30-day free look.

      C.  the right to increase the daily benefits at any anniversary with no evidence of insurability.

      D.  the right to offset applicable Medi-Cal requirements.

 

5.  Every LTCI policy in California must cover pre-existing conditions that are

      A.  discovered during the underwriting procedure.

      B.  admitted during a face-to-face paramedical interview.

      C.  disclosed on the application no later than 6 months following the effective date of coverage

            of the insured regardless of the date of the loss or confinement commences.

      D.  disclosed on the application no later than 6 months following the effective date of coverage
      of the insured if the date of loss or confinement occurred immediately prior to application.

 

6.  A provision forbidden in California LTCI policies is

      A.  that elimination periods may not be less than 6 months or more than 1 year.

      B.  home health care benefits must exceed policy daily benefits by 25% minimum.

      C.  nursing home benefits must not exceed 120% of the national average cost.

D.  that there shall be no termination of coverage by the insurer when the insured is institutionalized that began when the policy was in force, and continues without interruption.

 

7.  The average cost per day of nursing home care in California (2004) was

      A.  $200.

      B.  $300.

      C.  $165.

      D.  $225.

 

8.  The average cost of long-term care in California from 1980 to 1998

      A.  decreased by 7% annually.

      B.  remained the same- within .5% points.

      C.  increased 6.7%.

      D.  increased by 25%.

 

9.  In respects to inflation protection on California approved LTCI policies,

      A.  coverage is mandatory, 5%  compounded annually.

      B.  coverage is mandatory, 5% compounded annually or simple interest calculation.

      C.  insurers must offer to each policyowner, at time of purchase, an inflation protection option.

      D.  the insurers must allow each policyowner to increase benefits without evidence of insurability every three years at a rate of 8% compounded every 3-year period.

 

10.  Consumer Reports on their report on Long Term Care Insurance, advises consumers

      A.  to forget all about LTCI policies, as they are “rip-offs.”

      B.  not to buy a LTCI policy without inflation protection.

      C.  not to buy a LTCI policy with inflation protection as they are too expensive.

      D.  to buy only LTCI policies issued by a mutual company.

 

ANSWERS TO STUDY QUESTIONS

1A     2A     3C     4B     5C     6D     7C     8C     9C     10B