How Are Benefits Paid?
Either by each expense or by a set dollar amount.
What Services Are Covered?
Policies vary and may cover nursing home care, home health care, personal care in your home, services in assisted-living facilities, services in adult day care centers and/or services in other community facilities.
Where Are Services Covered?
Insurance policies cover different types of facilities. If your facility is not covered, the insurance company can refuse to pay for eligible services.
What Is Not Covered (exclusions and limitations)?
Most policies usually do not pay benefits for a mental or nervous disorder or disease, other than Alzheimer's or other dementia; alcohol or drug addiction; illness or injury caused by an act of war; treatment the government has provided in a government facility or already paid for; or attempted suicide or intentionally self-inflicted injuries.
How Much Coverage You Will Have?
A policy may have a maximum benefit limit or a daily/monthly benefit limit.
When Are You Eligible for Benefits (benefit triggers)?
Some policies use more than one way to decide when to pay benefits, while some states require certain benefit triggers. Benefit triggers may include:
The inability to do activities of daily living such as bathing, continence, dressing, eating, toileting and transferring (most common benefit trigger).
Cognitive impairment/mental incapacity
Doctor certification of medical necessity
Prior hospitalization. Most companies no longer sell policies that require a hospital stay, although Medicare requires a three-day hospital stay to be eligible for Medicare payment of skilled nursing facility benefits.
When Do Benefits Start?
Most policies have a waiting period, or elimination period, of 0, 20, 30, 60, 90 or 100 days before benefits start.