Most people report uncertainty about the definition of claim triggers in their long term care insurance policy. My experience confirms that people want a better understanding about what IS covered and what MAY NOT be covered. You will be surprised about today’s long term care policies and find they DO cover you when you need it most.

The issue of Long Term Care is at the top of the list of retirement threats facing many of us. It is one of the largest uninsured financial risks facing the elderly in the United States today. Incredibly, long term care represents about 8½ percent of all health care spending for all ages and more than 1 percent of GDP.

Eligible claims: Let’s focus on what many people find confusing – benefit triggers and when can you claim? For example, the REQUIRED wording for chronically ill is:

  1. You cannot perform at least two activities of daily living without substantial assistance for at least 90 consecutive days; or
  2. Cognitive impairment issues creating and requiring supervision in order to protect you from health and safety threats.

These are standard and straightforward definitions. Being aware of them will lead to the receipt of proper benefits under the contract. 

The benefits are in the details! Looking closer at number One:

‘You cannot perform at least two activities of daily living without substantial assistance…’ Does this definition require the insured to be sick in order to meet the chronically ill definition?

No. These benefits are triggered by a loss of functional capacity – meaning you cannot manage Activities of Daily Living  (ADL) without assistance.

Activities of Daily Living (ADLs) are defined as “the things we normally do… such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure activities”.

Eligibility of claims in these cases IS NOT tied to a specific diagnosis or injury. You are not required by the policy to have MS, Parkinson’s, a stroke or any other diagnosed medical condition. You might be 70 years old or 85 years old – that does not matter.

A large number of people receiving long term care benefits do have one or more chronic conditions but do not have a catastrophic diagnosis. They are still eligible for claims under the right contracts. 

Without a doubt, the longer we live, the more likely it is that we will need help with our daily living activities.

Fortunately, being sick is not a requirement to receive legitimate benefits.

Please feel free to contact me to arrange a consultation about long term care.  There are dozens of threats to your nest egg in retirement and I will explain this one and any others you wish to discuss. You can email me or call me directly at 561-869-4500.

Also published on Medium.


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