Waiver of Premiums and Reinstatement of Long Term Care Policy and Cognitive Impairment

The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will not be paid. Most policies contain provisions similar to those outlined below.

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We will waive Your premium starting on the first day of the Policy Month which starts on or next follows the later of the date on which You: (1) become eligible for Benefits; and (2) satisfy the Elimination Period. You must resume payment of Your premium starting on the first day of the Policy Month, which starts on or next follows the date on which You are no longer eligible for Benefits.

Reinstatement The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will not be paid. Most policies contain provisions similar to those outlined below.

If Your Policy Lapses, We will reinstate Your Policy back to the date it Lapsed, if within twelve (12) months of that date You or someone acting for You:

1. Request reinstatement;
2. Submit proof of good health, acceptable to Us, at Your expense; and
3. Pay all past due premiums to Us, if We approve Your request for reinstatement.

If We reinstate Your Policy, Your premium will be what it would have been if Your coverage had not Lapsed.

Reinstatement for Cognitive Impairment or Loss of Functional Capacity

The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will not be paid. Most policies contain provisions similar to those outlined below.

If Your Policy Lapses, We will reinstate Your Policy back to the date it Lapsed, without proof of Your good health, if within six (6) months of that date, You or someone acting for You:

1. Request reinstatement;
2. Submit proof acceptable to Us that You had a Severe Cognitive Impairment or loss of functional capacity before the Policy Lapsed; and
3. Pay all past due premiums to Us, if We approve Your request for reinstatement.

The standard of proof We will use will be no more restrictive than that described in the Eligibility for the Payment of Benefits section.

If We reinstate Your policy, Your premium will be what it would have been if Your coverage had not Lapsed.

Case Studies on Waiver of Premiums, Long Term Care Policy Reinstatement, and Cognitive Impairment.

Case Study 1: Waiver of Premiums

In this case, an individual holds a long-term care insurance policy and has been paying premiums regularly. However, they are diagnosed with a chronic illness that requires long-term care, rendering them unable to work and afford the policy premiums. The policy includes a provision for a Waiver of Premium benefit, which allows the insured person to stop paying premiums while still maintaining the coverage.

By invoking the Waiver of Premium provision, the individual can have their policy premiums waived and continue to receive the benefits of the long-term care policy. This provision becomes crucial in providing financial relief to the insured person during their time of need, ensuring that they can access the necessary care without the added burden of premium payments.

Case Study 2: Reinstatement of Long Term Care Policy

In this case, an individual allowed their long-term care insurance policy to lapse due to non-payment of premiums. However, within the specified timeframe (usually 12 months), they realize the importance of maintaining the coverage and want to reinstate the policy. The policy includes a provision for reinstatement, which allows the insured person to restore their coverage back to the date of the lapse, subject to certain conditions.

To reinstate the policy, the insured person needs to submit all overdue premiums and may be required to provide proof of good health. If the conditions for reinstatement are met, the insurance company will agree to reinstate the long-term care policy, ensuring that the insured person continues to have access to the benefits and protection it offers. Reinstatement provides an opportunity for individuals to rectify the lapse in coverage and safeguard their future long-term care needs.

Case Study 3: Cognitive Impairment and Reinstatement

In this case, an individual allowed their long-term care insurance policy to lapse due to non-payment of premiums. However, within the specified timeframe (usually six months), they are diagnosed with cognitive impairment or a loss of functional capacity. The policy includes a provision for reinstatement in cases of cognitive impairment, which allows the insured person to reinstate the policy without the need for proof of good health.

To reinstate the policy, the insured person needs to submit all overdue premiums within the specified timeframe. The insurance company will reinstate the long-term care policy back to the date of the lapse, ensuring that the individual has coverage despite their cognitive impairment or loss of functional capacity. This provision recognizes the challenges faced by individuals with cognitive impairments and provides them with an opportunity to reinstate their coverage and receive the necessary long-term care benefits.