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Long term care
is the type of care that a person receives when they can no longer care for
themselves. It includes a wide range of mostly non-medical services that are
designed to help people maintain the maximum level of independence. Care can
be custodial, intermediate or skilled in nature and can be provided in the
home, community or institutional setting. Long term care can be provided in a
formal or informal manner. Formal long term care refers to services that are
paid for while family or friends provide informal care.
The three generic types of
coverage are typically called nursing facility, home care and comprehensive,
which includes both nursing and home care coverage.
Average Cost for a private room in a nursing home in Los Angeles is
$175/day. Average hourly home heath care is
$15.
2010 Updates
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lifestyleinsurance.com
§10232.8 |
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Advantages to buy NOW, prior to age 65.
(1) He probably is a preferred risk at this time, he may not be later - at age 65
(2) A lifetime premium today will be about $2,900 for a 5 year benefit period vs $8,000 at age 65. It will probably be even higher as the daily cost will be around $300 compared to $200 today, so his premium will be closer to $10,000.
He can purchase a limited pay plan (paid up in 10 years) today for the same premium is will cost him at age 65.
The advantage of a limited pay plan is that he will have no premium outlay when he retires.
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Medicare
does NOT pay for Long Term Care
(Page 65).
Medi-cal (MediCaid) Welfare,
might pay, however if you have $$$ or Property, they might put a
lien on your home. |
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Consumer Brochures
             
We also have plans if you have Medicare and you are under 65 Consumer Links
LTC
Consultant's
LTC Glossary
Genworth Glossary Home Health Care in CA
CHCF Site
California Department
on Aging
cal medicare.org/
Home Health Care in CA - CHCF Site
ca health advocates.org/long-term
Claims Information
How to File
free advice.com
genworth.com
d i law group.com/
Technical & Broker Links
Tax Deduction for Long Term Care
IRS
Publication 502
Prevent & Report Elder Abuse CA Attorney General
California Partnership Website
California Partnership3 Page ExplanationNo CLASS Act - No Funding
CHAPTER 2.6. LONG-TERM CARE INSURANCE
Definitions ............... 10231-10231.8
General Provisions ........ 10232-10233.9
Administration and Enforcement10234-10234.7
Consumer Protection .......10234.8-10234.97
Implementation ............. 10235-10236.8
AInflation Escalator and Benefit Increases10237-10237.6
Minimum LTC Coverage 10232.8.
(a) In every long-term care policy or certificate that is
not intended to be a federally qualified long-term care insurance
contract and provides home care benefits, the threshold establishing
eligibility for home care benefits shall be at least as permissive as
a provision that the insured will qualify if either one of two
criteria are met:
(1) Impairment in two out of seven activities of daily living.
(2) Impairment of cognitive ability.
The policy or certificate may provide for lesser but not greater
eligibility criteria. The commissioner, at his or her discretion, may
approve other criteria or combinations of criteria to be
substituted, if the insurer demonstrates that the interest of the
insured is better served.
"Activities of daily living" in every policy or certificate that
is not intended to be a federally qualified long-term care insurance
contract and provides home care benefits shall include
eating,
bathing,
dressing,
ambulating,
transferring,
toileting, and
continence;
"impairment" means that the insured needs human
assistance, or needs continual substantial supervision; and
"impairment of cognitive ability" means deterioration or loss of
intellectual capacity due to organic mental disease, including
Alzheimer's disease or related illnesses, that requires continual
supervision to protect oneself or others.
(b) In every long-term care policy approved or certificate issued
after the effective date of the act adding this section, that is
intended to be a federally qualified long-term care insurance
contract as described in subdivision (a) of Section 10232.1, the
threshold establishing eligibility for home care benefits shall
provide that a chronically ill insured will qualify if either one of
two criteria are met or if a third criterion, as provided by this
subdivision, is met:
(1) Impairment in two out of six activities of daily living.
(2) Impairment of cognitive ability.
Other criteria shall be used in establishing eligibility for
benefits if federal law or regulations allow other types of
disability to be used applicable to eligibility for benefits under a
long-term care insurance policy. If federal law or regulations allow
other types of disability to be used, the commissioner shall
promulgate emergency regulations to add those other criteria as a
third threshold to establish eligibility for benefits. Insurers shall
submit policies for approval within 60 days of the effective date of
the regulations. With respect to policies previously approved, the
department is authorized to review only the changes made to the
policy. All new policies approved and certificates issued after the
effective date of the regulation shall include the third criterion.
No policy shall be sold that does not include the third criterion
after one year beyond the effective date of the regulations. An
insured meeting this third criterion shall be eligible for benefits
regardless of whether the individual meets the impairment
requirements in paragraph (1) or (2) regarding activities of daily
living and cognitive ability.
(c) A licensed health care practitioner, independent of the
insurer, shall certify that the insured meets the definition of
"chronically ill individual" as defined under Public Law 104-191. If
a health care practitioner makes a determination, pursuant to this
section, that an insured does not meet the definition of "chronically
ill individual," the insurer shall notify the insured that the
insured shall be entitled to a second assessment by a licensed health
care practitioner, upon request, who shall personally examine the
insured. The requirement for a second assessment shall not apply if
the initial assessment was performed by a practitioner who otherwise
meets the requirements of this section and who personally examined
the insured. The assessments conducted pursuant to this section shall
be performed promptly with the certification completed as quickly as
possible to ensure that an insured's benefits are not delayed. The
written certification shall be renewed every 12 months. A licensed
health care practitioner shall develop a written plan of care after
personally examining the insured. The costs to have a licensed health
care practitioner certify that an insured meets, or continues to
meet, the definition of "chronically ill individual," or to prepare
written plans of care shall not count against the lifetime maximum of
the policy or certificate. In order to be considered "independent of
the insurer," a licensed health care practitioner shall not be an
employee of the insurer and shall not be compensated in any manner
that is linked to the outcome of the certification. It is the intent
of this subdivision that the practitioner's assessments be unhindered
by financial considerations. This subdivision shall apply only to a
policy or certificate intended to be a federally qualified long-term
care insurance contract.
(d) "Activities of daily living" in every policy or certificate
intended to be a federally qualified long-term care insurance
contract as provided by Public Law 104-191 shall include eating,
bathing, dressing, transferring, toileting, and continence;
"impairment in activities of daily living" means the insured needs
"substantial assistance" either in the form of "hands-on assistance"
or "standby assistance," due to a loss of functional capacity to
perform the activity; "impairment of cognitive ability" means the
insured needs substantial supervision due to severe cognitive
impairment; "licensed health care practitioner" means a physician,
registered nurse, licensed social worker, or other individual whom
the United States Secretary of the Treasury may prescribe by
regulation; and "plan of care" means a written description of the
insured's needs and a specification of the type, frequency, and
providers of all formal and informal long-term care services required
by the insured, and the cost, if any.
(e) Until the time that these definitions may be superseded by
federal law or regulation, the terms "substantial assistance,"
"hands-on assistance," "standby assistance," "severe cognitive
impairment," and "substantial supervision" shall be defined according
to the safe-harbor definitions contained in Internal Revenue Service
Notice 97-31, issued May 6, 1997.
www.unclefed.com
(f) The definitions of "activities of daily living" to be used in
policies and certificates that are intended to be federally qualified
long-term care insurance shall be the following until the time that
these definitions may be superseded by federal law or regulations:
(1) Eating, which shall mean feeding oneself by getting food in
the body from a receptacle (such as a plate, cup, or table) or by a
feeding tube or intravenously.
(2) Bathing, which shall mean washing oneself by sponge bath or in
either a tub or shower, including the act of getting into or out of
a tub or shower.
(3) Continence, which shall mean the ability to maintain control
of bowel and bladder function; or when unable to maintain control of
bowel or bladder function, the ability to perform associated personal
hygiene (including caring for a catheter or colostomy bag).
(4) Dressing, which shall mean putting on and taking off all items
of clothing and any necessary braces, fasteners, or artificial
limbs.
(5) Toileting, which shall mean getting to and from the toilet,
getting on or off the toilet, and performing associated personal
hygiene.
(6) Transferring, which shall mean the ability to move into or out
of bed, a chair or wheelchair.
Katz ADL scale
Lawton IADL scale
The commissioner may approve the use of definitions of "activities
of daily living" that differ from the verbatim definitions of this
subdivision if these definitions would result in more policy or
certificate holders qualifying for long-term care benefits than would
occur by the use of the verbatim definitions of this subdivision. In
addition, the following definitions may be used without the approval
of the commissioner: (1) the verbatim definitions of eating,
bathing, dressing, toileting, transferring, and continence in
subdivision (g); or (2) the verbatim definitions of eating, bathing,
dressing, toileting, and continence in this subdivision and a
substitute, verbatim definition of "transferring" as follows:
"transferring," which shall mean the ability to move into and out of
a bed, a chair, or wheelchair, or ability to walk or move around
inside or outside the home, regardless of the use of a cane,
crutches, or braces.
The definitions to be used in policies and certificates for
impairment in activities of daily living, "impairment in cognitive
ability," and any third eligibility criterion adopted by regulation
pursuant to subdivision (b) shall be the verbatim definitions of
these benefit eligibility triggers allowed by federal regulations. In
addition to the verbatim definitions, the commissioner may approve
additional descriptive language to be added to the definitions, if
the additional language is (1) warranted based on federal or state
laws, federal or state regulations, or other relevant federal
decision, and (2) strictly limited to that language which is
necessary to ensure that the definitions required by this section are
not misleading to the insured.
(g) The definitions of "activities of daily living" to be used
verbatim in policies and certificates that are not intended to
qualify for favorable tax treatment under Public Law 104-191 shall be
the following:
(1) Eating, which shall mean reaching for, picking up, and
grasping a utensil and cup; getting food on a utensil, and bringing
food, utensil, and cup to mouth; manipulating food on plate; and
cleaning face and hands as necessary following meals.
(2) Bathing, which shall mean cleaning the body using a tub,
shower, or sponge bath, including getting a basin of water, managing
faucets, getting in and out of tub or shower, and reaching head and
body parts for soaping, rinsing, and drying.
(3) Dressing, which shall mean putting on, taking off, fastening,
and unfastening garments and undergarments and special devices such
as back or leg braces, corsets, elastic stockings or garments, and
artificial limbs or splints.
(4) Toileting, which shall mean getting on and off a toilet or
commode and emptying a commode, managing clothing and wiping and
cleaning the body after toileting, and using and emptying a bedpan
and urinal.
(5) Transferring, which shall mean moving from one sitting or
lying position to another sitting or lying position; for example,
from bed to or from a wheelchair or sofa, coming to a standing
position, or repositioning to promote circulation and prevent skin
breakdown.
(6) Continence, which shall mean the ability to control bowel and
bladder as well as use ostomy or catheter receptacles, and apply
diapers and disposable barrier pads.
(7) Ambulating, which shall mean walking or moving around inside
or outside the home regardless of the use of a cane, crutches, or
braces.
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