Partnership Long-Term Care Policies

4-Hour Refresher Course

Table of Contents

Table of Contents to be used as an outline, page numbers will not match online book.

Chapter 1: Partnership Program Creation	6
Defining Long-Term Care	7
History of the Partnership for Long-Term Care	10
RWJF had specific goals	13
Partnership Policies are Created	14
Chart: Original 4 Partnership State Programs	15
Medicaid is the Largest Nursing Home Payor	16
Chart: Dollar-for Dollar asset protection	19
The Deficit Reduction Act of 2005 Provides Asset Protection	20
OBRA 1993 Provisions Pertaining to the Partnership for LTC	21
Agent and Consumer Education	23
Policy Benefits	25
Inflation Protection	25
Reciprocity Between States	26
State Funding	27
Chapter 2: Program Benefits	28
Making Benefit Choices	28
Buying Decisions	29
Daily Benefit Options	30
Determining Benefit Length	32
Asset Protection in Partnership Policies	32
Policy Structure	33
Home Care Options	34
Inflation Protection	34
Simple and Compound Interest	35
Required Rejection Forms (in some states)	36
Elimination Periods in LTC Policies	36
Policy Type	37
Restoration of Policy Benefits	38
Preexisting Periods in Policies	38
Medicare Prior Hospitalization Requirements for Skilled Care	39
Deciding Between Federal Tax-Qualified & State Non-Tax    Qualified (Non-Partnership) Policies	39
Nonforfeiture Values	40
Waiver of Premium	41
Unintentional Lapse of Policy	42
Policy Renewal Features	42
Items Not Covered by the LTC Policy	43
Extension of Benefits	44
Affordability of Contracts	44
Standardized Definitions	44
Minimum Partnership Requirements	45
Benefit Duplication	45
Partnership Publication	45
Abbreviations	46
Truly a Partnership	47
Saving Assets from Medicaid Qualification	48
Accessing Policy Benefits	49
Asset Repositioning	52
Partnership Participation will not Guarantee Medicaid Qualification	53
Chapter 3: Basic Policy Considerations for                   Traditional LTC Policies	55
What is a Traditional Long-Term Care Policy?	55
Policy Issue	56
Qualified LTC Partnerships under DRA 2005	57
Definition of Qualified State LTC Partnership Policy	57
Meeting Partnership Eligibility Requirements	58
Grandfather Clause	60
NAIC Model Regulations	60
Partnership Plans Protect Assets, Not Income	61
Age as an LTC Policy Factor	62
Reducing Benefits to Save Premium	63
Policy Renewal	64
Policy Review: 30 Day “Free Look”	65
“Notice to Buyer”	65
Policy Schedule	66
Policy Terminology	66
Policy Termination	72
Mental Impairments of Organic Origin	72
Hospitalization Requirements	73
Home and Community Based Benefits	74
Bed Reservation Benefit	74
Waiver of Premium	75
Selecting Other Types of Care	76
No Policy Covers Everything	76
Age Misstatement	78
Third Party Notification	78
Reinstatement of a Lapsed Policy	79
Section 6021: Expansion of State LTC Partnership Program	80
NAIC 2000 Model Act	82
“Level Premium” Does Not Mean Unchanging Rates	84
Financial Requirements for Rate Increases	84
Rate Certification from the Insurer’s Actuary	85
Consumer Disclosure	85
LTC Personal Worksheet	85
Is the Policy Suitable for the Buyer?	86
Consumer Publications	86
Post-Claim Underwriting	87
Tax-Qualified Policy Statement	87
Replacement Notices	88
Policy Conversion	88
An Overview	89
The Model Act Applies to All	89
Policy Renewable Provisions	90
Payment Standards Must be Defined	91
Preexisting Standards	91
Policy Type Must be Identified	91
ADLs	91
Life Insurance Policies with Accelerated Benefits	92
Nonforfeiture Provisions	92
Extension of Benefits	93
Home & Community Care	93
Additional Provisions for Group Policies	93
Outline of Coverage	93
Policy Delivery	94
No Field Issued LTC Policies	94
Policy Advertising and Marketing	94
No Policy Covers Everything (Again)	94
Prior to the Sale	95
Shopper’s Guide	95
Twisting, high pressure Tactics: Just Plain Illegal	95
Association Marketing	96
Following the Sale	96
Failure to Pay Premiums	96
In Conclusion	97
Chapter 4: Financial Planning for LTC	98
The Importance of Planning	98
Factors Increasing Use of Long-Term Care	100
Average Costs in US	103
Chart: Long-Term Care Services	104
Chapter 5: Terminology	106-112

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