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Products: Long-term care/Home health care insurance

What is long-term care?

Long-term care is the type of assistance people need when they can no longer perform some or all basic activities of daily living (ADLs), which can include eating, bathing, continence, dressing, toileting and transferring (that is, moving in or out of a bed, chair or wheelchair). Long-term care needs typically arise as part of the normal aging process, but they also can be due to an injury or illness, such as multiple sclerosis, stroke or rheumatoid arthritis, or due to a cognitive impairment like Alzheimer’s disease.

Where is long-term care provided?

Long-term care does not necessarily mean a nursing home. You can receive long-term care in a variety of settings, including:

  • Adult day care center, where care is provided during the day for adults, usually in a public group setting.
  • Assisted living facility, a residential arrangement that may provide personalized care and health services. Residents may need help with activities of daily living like bathing and dressing. This type also may be called custodial care, domiciliary care, intermediate care, personal care, residential health care, sheltered care or supported care facilities.
  • Hospice care, provided to relieve pain and manage the symptoms associated with a terminal illness and any related conditions. Hospice care may be provided by an agency that specializes in relieving pain, managing symptoms and supporting dying persons and their families.
  • Nursing home, a licensed facility providing around-the-clock room and board, nursing care and personal services. Nursing homes also may offer medical care, therapy and other health-related services.
  • Your home, where you can receive services and supplies without having to leave. Common options are home health care, adult day care, hospice care and respite care.

Other types of long-term care include:

  • Custodial care (also called personal care), which helps you perform the activities of daily living with help from someone who doesn’t have professional medical training.
  • Skilled nursing care, daily nursing and rehabilitative care performed only by or under the supervision of skilled medical personnel.
How much does long-term care insurance cost?

The cost of long-term care insurance varies based on the coverage type and amount you choose. Your premium is also determined by your age/gender, the length of coverage, your current health, the elimination period (that is, the amount of time before your insurance policy begins to pay benefits) and the maximum dollar amount you can be reimbursed for covered expenses.

What does “chronically ill” mean?

“Chronically ill” means you have been certified by a licensed health care practitioner within the preceding 12 month period as:

  1. Being functionally incapacitated for a period expected to last at least 90 days.
  2. Having a severe cognitive impairment.
If Medicare paid for my expenses, should I still file a claim with Bankers Life?

Yes. If your Bankers Life policy has an elimination period, your Medicare-covered expenses could satisfy that requirement. Remember, your policy’s benefit-eligibility requirements still must be met before expenses will be paid.

Can I hire a family member to provide home health care for me?

Your policy may have an exclusion that prevents benefits from being paid for care by an immediate family member. Be sure to review your policy to see if it has this exclusion.

If it does not have this exclusion, benefits may be paid for home health care provided by an immediate family member. That individual will simply need to meet the provider-eligibility requirements described in your policy. Contact the Bankers Life customer service department before care begins to verify that the family member meets your policy requirements.

I have a home health care agency I want to use. How can I find out if it’s an eligible provider with my policy?

Contact the Bankers Life customer service department before care begins. We can then verify whether the agency meets all policy requirements. If necessary, we can provide names and contact information for eligible agencies in your area.

Does my policy pay benefits for someone to clean my house?

Many Bankers Life policies pay benefits to cover “homemaker services.” You must meet your policy’s eligibility requirements for benefits to be paid. Check your policy for specific information. If you’re still unsure, contact our customer service department for support.

Does my Home Health Care Only policy pay for expenses in a nursing home or assisted-living facility?

Under most circumstances, it does not. Most Home Health Care Only insurance policies require that a home health care agency or similar entity provide services. Nursing homes and assisted-living facilities are not considered home health care providers.

What are the requirements for an independent caregiver?

An independent caregiver must meet the policy requirements to be considered an eligible provider. Home health care services provided by an independent caregiver—that is, a caregiver who is not employed by a home health care agency—may qualify for benefits if that individual currently meets one of the following:

  • A licensed Registered Nurse.
  • A licensed Practical Nurse.
  • A Certified Nurse Aide.
  • Included in a government-sponsored Nurse Aide Registry.

Note: These criteria don’t apply to independent caregivers in California.

Is there a waiting period before my policy pays benefits?

Most Bankers Life policies have an elimination period or deductible. An elimination period is similar to a waiting period. Benefits aren’t paid for an approved claim until after a certain number of days pass. The exact language and number of days will vary by policy. If you have questions, please contact our customer service department.

Is there a deadline for submitting claims?

Every Bankers Life insurance policy defines the timeframe during which we must receive the claim. Your state’s insurance regulations may vary from this standard and will always override your policy’s provisions.

How long does it take to process my claim?

Each state defines the timeframe companies have to pay eligible benefits. Refer to the Prompt Pay law guidelines in your state for your policy type.

To process your claim quickly and accurately, we must gather specific information from your care provider. When you can help us gather the required documents and supply any missing information, you can prevent or decrease delays.

Our claim department will review your documents to verify that we’ve received all required information. The claim will then be reviewed for eligibility. Bankers Life will communicate with the claimant and/or legal guardian throughout the process.

Should I file a claim before or after I begin receiving care?

Most Bankers Life insurance policies are “expense incurred” policies. In other words, care must begin with the provider before a claim can be filed and processed.

Can I submit a claim on behalf of a Bankers Life insured?

If the insured won’t be handling the claim personally, Bankers Life requires certain documentation before benefits can be paid. For an authorized representative to manage a claim on the policyholder’s behalf, we must receive one of the following:

  1. A signed third-party authorization form.This document simply authorizes Bankers Life to disclose information to a designated individual over the phone or in writing.  This form does not give the authorized party the same legal authority as a power of attorney or legal guardian. Visit our service and support page to download the authorization form.
  2. A copy of a health care or durable power of attorney (POA) document.
    This document may authorize the specified individual to make health care or financial decisions, provide information or handle business affairs for your policy.  The POA documentation defines the authority granted to that individual.  Visit our service and support page to download the authorization document.
Can I file a claim for my medical alert system?

Many Bankers Life insurance policies pay a benefit for emergency medical response systems, such as Life Alert®. The system must meet your policy’s benefit-eligibility requirements to qualify. Please review your policy for details. If you’re still unsure, contact our customer service department.