In order to receive your long-term care insurance benefits, you need to trigger your benefits, satisfy the elimination period and file a claim.
Benefit triggers
Benefit triggers are what will determine if you are already eligible to claim your benefits. Typically, benefits will start being in effect once you can no longer perform two or three Activities of Daily Living, which are bathing, dressing, eating, transferring, grooming, and continence.
Meanwhile, cognitive conditions like Alzheimer’s disease can also trigger your benefits. However, there are instances when Alzheimer’s patients are still able to perform ADLs. When a person is diagnosed with a cognitive condition, companies may perform mental-function tests instead of looking at the person’s capability to perform ADLs to justify if he or she is already qualified for benefits.
To determine if you met the benefit triggers requirement, a nurse or social worker will assess your condition.
Satisfying the elimination period
Apart from triggering your benefits, you also need to satisfy the elimination period indicated in your policy. This acts like a deductible, but it is measured by the amount of time you wait. During this period, you will have to shoulder your own care expenses.
Elimination periods can be counted by service days and calendar days, and you need to know which between the two is written in your policy. If your policy only recognizes the service days, only the days that you receive care will be deducted against your waiting period. On the other hand, if your policy deducts through calendar days, each day following the first day you triggered your benefits will be counted against your elimination period, regardless if you receive care on some days or not.
Making a Claim
In order to receive your benefits, you need to file a claim. When you triggered your benefits, you need to call your insurer immediately and inform them of your condition. Even if your elimination period is not yet over, getting in touch with your insurer is essential as it starts the evaluation process early on.
Submit all the necessary requirements and make sure that all the information you provide are accurate and complete. This will avoid any delay and any disputes that may arise due to discrepancies and inconsistencies in your paperwork.
Insurers usually require you to submit a completed claim form, plan of care, physician’s recommendation, receipts, and bills.
Once the insurer confirms that you’re eligible, you will start receiving benefits. Meanwhile, they will ask more information from you if they need to further assess your condition.
