Long Term Care continued

Terminology

Note: Most of this is common sense, but be sure to know the terms that have asterisks (***).

Long-term care insurance policy means any insurance policy or rider designed to provide coverage for one or more necessary or medically necessary services provided in a setting other than an acute care unit of a hospital.

******Chronically ill means a physician has certified the person as:

• unable to perform, without substantial assistance, at least two activities of daily living for at least 90 days due to a loss of functional capacity; or
• requiring substantial supervision for health and safety due to sever cognitive impairment.

******Cognitive impairment means loss of a person's short-term or long-term memory, orientation as to place and time, or judgment as it relates to safety awareness.

Qualified long-term care services means necessary diagnostic, preventive, curing, treating, mitigating, and rehabilitative services, and maintenance or personal care services that are required by a chronically ill individual.

Adult day care center means a social and health-related services program for six or more individuals provided in a community group setting.

Home health services means medical and non-medical services provided to persons in their residences including homemaker services, assistance with activities of daily living, and respite care services.

Nursing home facility means any facility that provides services for the care and comfort of individuals.

Personal care means the provision of hands-on services to assist an individual with activities of daily living

LTC provides benefits for many different environments of care, but does NOT include benefits for Hospital room and board, hospice, or psychiatric facilities (but all three of those ARE covered under Medicare Part A).

Waiting period or probationary period means that period of time that follows the date a person is initially insured before the coverage of the policy must become effective as to that person.