Long Term Care FAQs

Long term care (or LTC) refers to the services that help you with basic Activities of Daily Living (ADLs), which include:

Bathing

• washing yourself by sponge bath or in either a tub or shower
• getting into or out of the tub or shower

Dressing

• putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs
• you will be considered able to dress yourself even if these tasks can only be performed by using modified clothing or adaptive devices such as tape fasteners or zipper pulls

Continence

• maintaining control of bowel and bladder function
• when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene, including caring for a catheter or colostomy bag

Toileting

• getting to and from the toilet
• getting on and off the toilet
• performing associated personal hygiene

Eating

• feeding yourself by getting food into the body from a receptacle (such as a plate, cup, or table)
• when unable to feed yourself from a receptacle, feeding yourself by a feeding tube or intravenously

Transferring

• getting into or out of a bed, chair, or wheelchair
• you will be considered able to transfer even if you use or require equipment such as canes, quad canes, walkers, crutches, grab bars, or other support devices, including mechanical or motorized devices, in order to transfer or ambulate

Long term care can also refer to services needed to protect your health when you have a severe cognitive impairment, like advanced Alzheimer's. These services can be received at home or in a facility.

You can qualify if you need substantial assistance with at least three of six basic Activities of Daily Living (ADLs), expected to last at least 90 days. The six Activities of Daily Living are bathing, dressing, toileting, eating, getting in and out of bed or a chair (also called transferring), or managing bowel and bladder continence (peeing and pooping).

You can also qualify if you have a severe cognitive impairment, like advanced Alzheimer's and need continuous supervision.
 

Contact us, and we'll provide an Application (Opens in new window), along with Provider Certification (Opens in new window) and Plan of Care forms (Opens in new window) for your doctor. You doctor’s dated signature starts the elimination period.

The elimination (waiting) period varies depending on your plan. You can find this information on the Benefit Summary we mailed to you. Your elimination period starts when your doctor signs the Provider Certification form (Opens in new window) and Plan of Care form (Opens in new window) along with medical records that align with those forms. Therefore, notify us early to start the process.

The amount of Maximum Daily Benefit (MDB) varies from plan to plan. Yours is on your Benefit Summary which was mailed to you. This refers to the percentage of charges that we cover, up to the "Maximum Daily Benefit" (MDB). You are responsible for paying for charges above and beyond the Maximum Daily Benefit. 

Not usually. Benefits are for impairments expected to last 90 days or longer, not short-term recovery. These expenses are often covered by your health plan.

Your plan covers various care settings, including nursing homes, assisted living, adult day care, hospice, home care, and respite care.

No, except for Respite Care, which offers temporary relief for primary caretakers.

It pays someone else to temporarily care for you when your primary caretaker, like your spouse, needs a break. Respite Care is provided on a temporary, substitute basis, to enable the regular caregiver, who must live with the Chronically Ill individual, to take a rest or vacation from providing care. Respite Care is limited to the number of days specified on your Benefit Summary for each Benefit Period. It may be provided by non-licensed providers or by members of the Chronically Ill individual’s Immediate Family.

Medicaid can cover some LTC services, but in order to qualify, you need to meet income and asset requirements.

Medicaid is a “public assistance” program. Its availability is limited to people who meet strict income and asset guidelines (or those who are pregnant, or people with specific additional circumstances). 

Medicaid is a joint state-federal program. Each state is allowed to independently operate its own Medicaid system, providing roughly half the funding. They are responsible for distributing the remaining half, which is supplied through federal money. State-administered Medicaid systems must conform to federal guidelines, or federal money will be withheld.

Medicaid not only covers ongoing and emergent medical care, like doctor visits or hospital costs. Medicaid is also the largest public payer of long term care services, providing coverage for services in nursing homes, including custodial care, services provided at home, including visiting nurses and assistance with personal care, and community-based services such as personal care services, laundry and cleaning support, and case management.

Here is a link to the Group LTC Plan Document (Opens in new window) and Individual LTC Plan Document (Opens in new window). For future reference, you'll find these and all forms on our website under Forms. 

Yes, but only for general information. We can't discuss your medical history, claims, or benefits without an authorization form: either Power of Attorney documentation or a Designation of Insurance Representative Form (Opens in new window). Then, we'll be able to speak with someone other than you regarding your coverage.

If you have Power of Attorney documentation, please submit that to us. View Contact Us for details.

Contact us regarding any changes, including address changes, deaths, or divorces, as required by the policy.

Request for Address Change form (Opens in new window)