Long-term care Insurance

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.

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

1. Being unable to perform two of six basic activities of daily living, which can include eating, bathing, continence, dressing, toileting, and transferring.
2. Having a severe cognitive impairment.

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.

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 from home health care provider 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.

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.

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

An independent caregiver must meet the policy requirements to be considered an eligible provider. Home health care services provided by 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.

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.

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

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 guardian throughout the process.

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.

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 specific 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.

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.