Elimination Period

Specific provisions in a typical long term care insurance policy govern your eligibility for benefits. These are defined below, with additional comment for clarification where needed.

_________

In order to be eligible for certain Benefits, you must also satisfy an Elimination Period, as described below.

“Elimination Period” is the number of days after the Original Coverage Effective Date of this Policy during which You must be: (1) Chronically Ill; and (2) receiving Primary Services (other than Hospice Care and Respite Care), before certain Benefits become payable. These days need not be consecutive. The Elimination Period for this Policy is shown on the Schedule of Benefits page. Except as stated below, Benefits will not be paid for Covered Services You receive during the Elimination Period.

No Elimination Period is required in order to receive Benefits for Hospice Care, Respite Care, Needs Assessment or Informal Caregiver Training. Receipt of these services will not count toward satisfying the Elimination Period.

You only have to satisfy the Elimination Period once. Once You have satisfied a day of the Elimination Period, that day is satisfied for the life of the Policy.

Case Studies: A Crucial Factor in Long Term Care Insurance

Case Study 1: Tailoring the Elimination Period to Manage Costs

John, a 55-year-old individual, is considering purchasing a long term care insurance policy. He understands that the length of the elimination period affects the cost of the premium. After assessing his financial situation and weighing the potential risk, John decides to opt for a longer elimination period of 180 days.

By choosing a longer elimination period, he can significantly reduce his premium payments, making the policy more affordable for him. John recognizes that this decision aligns with the purpose of long term care insurance, which is to safeguard against prolonged and expensive care needs in the future.

Case Study 2: Utilizing Primary Services to Meet the Elimination Period

Mary, a long term care insurance policyholder, requires nursing home care due to a decline in her health. Her policy includes nursing home services as part of the primary services that count toward the elimination period. Mary stays in a nursing home for 90 days, which satisfies her elimination period requirement.

After the elimination period is fulfilled, Mary becomes eligible to receive long term care insurance benefits for the covered services she receives. The elimination period acts as a waiting period during which Mary is responsible for the costs, but once it is met, the insurance coverage kicks in, providing financial support for her ongoing care needs.

Case Study 3: Balancing Elimination Period and Care Needs

Sarah, a 62-year-old individual, is planning for her long term care needs. She carefully evaluates the options for the elimination period in her long term care insurance policy. Sarah considers her ability to pay for long term care expenses and the quality/cost of the facilities she would prefer.

Given her financial circumstances and the potential duration of care, Sarah decides on a 60-day elimination period, striking a balance between cost and coverage. With this choice, Sarah ensures that she can receive benefits relatively soon after requiring long term care services while still maintaining a manageable premium.