When Should You Consider Using Your Long Term Care Benefits?

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In order to receive benefits from your policy, you must meet two criteria:

  1. The Benefit Trigger
  2. The Elimination Period.

Benefit triggers

Benefit triggers are the criteria than insurance company will use to determine if you are eligible for service.

  • Most companies use a specific assessment form that will be filled out by a nurse/social worker team.
  • Usually are defined in terms of cognitive impairments or activities of daily living
  • Most policies pay when you need help with two or more of six ADLs or when you have a cognitive impairment
  • Once you have been assessed, your care manager from the insurance company will approve a Plan of Care that outlines for which you are eligible.

    The Elimination Period

    The “Elimination Period” is the amount of time that must pass after a benefit trigger occurs before you start receiving payment for services.

    • Elimination Period is like the deductible you have on car insurance, except it is measured in time rather than by dollar amount.
    • Most policies allow you to choose a period of 30, 60, or 90 days at the time you purchase your policy.
    • During the period, you must cover the cost of any services you receive.

    Some policies specify that in order to satisfy an elimination period you must receive paid care or pay for services during that time. Most policies pay your costs up to a pre-set daily limit until the lifetime maximum is reached.

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