What Happens When You File a Long-Term Care Insurance Claim?
A claim starts when a licensed health care practitioner certifies that you need help with at least two of six daily activities, expected to last at least 90 days, or that you have a severe cognitive impairment. After a waiting period called the elimination period, benefits begin. With the coverage Staying Power offers, they’re paid as monthly cash.
What starts a claim?
Benefits start when a licensed health care practitioner certifies one of two things:
You can’t perform at least two of six activities of daily living (bathing, eating, dressing, toileting, continence, and transferring) without help, and the need is expected to last at least 90 days.
You need substantial supervision because of a severe cognitive impairment, such as Alzheimer’s disease, even if you can still do all six activities.
These are the standard triggers for tax-qualified long-term care policies. Each policy’s own terms decide the details. (NAIC Shopper’s Guide)
What happens after you file?
You contact the insurance company to start the claim. With Staying Power, you can start by calling us; we stay with you through the claim.
A licensed health care practitioner certifies that you meet a benefit trigger.
A plan of care is prepared, describing the care you need. With the coverage we offer, it also determines whether care from family or friends is appropriate.
The elimination period runs: 90 calendar days with the coverage we offer.
Once the elimination period is met and your claim is approved, benefits begin.
How does the elimination period work?
The elimination period is a waiting period before benefits are paid. With the coverage we offer, it’s 90 calendar days, and once it’s met, it’s met for the life of the policy. Benefits for those first 90 days are paid retroactively, together with month four. The NAIC notes that elimination periods commonly range from 20 to 100 days, and that some policies require you to meet one for each episode of care while others require it only once. (NAIC Shopper’s Guide)
How are benefits paid?
With the coverage we offer, benefits are paid as monthly cash. There are no monthly bills or receipts to submit once your claim is approved, though you need to keep meeting the policy’s claim requirements. See Can Long-Term Care Insurance Pay a Family Member?.
Do you have to requalify?
Your eligibility is recertified at least every 12 months, and sometimes sooner depending on your condition.
Who helps you through it?
The insurer provides claims support, including help understanding the process and finding local care services. Staying Power stays with you through the claim as well. If you’re planning for your own care, get started to see what care costs and how to fund it.
Related reading: What to Expect in Long-Term Care Insurance Underwriting and What Is a Tax-Qualified Long-Term Care Policy?.
Frequently asked questions
Does the elimination period start over if I need care again?
With the coverage we offer, no. Once the 90-day elimination period is met, it’s met for the life of the policy.
Do I need to send receipts?
With the coverage we offer, no. Benefits are paid as monthly cash once your claim is approved.
What counts as severe cognitive impairment?
A loss of memory or thinking ability, such as from Alzheimer’s disease, that means you need substantial supervision to stay safe, as certified by a licensed health care practitioner.
