Long
Term Care Glossary
of Terms
Activities
of Daily Living (ADLs) — Everyday
activities which are used to measure an individual’s
ability to function independently. The loss of
some number of ADLs is an insuring or triggering
event in all long-term care policies. In 1993,
California Senate Bill 1943 (Mello-1992) established
seven standardized activities of daily living
(eating, bathing, dressing, toileting, continence,
transferring, ambulating) for any LTC policy
that purports to cover home care in its provisions.
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Benefit
Maximum — Maximum amount of money and
or days of care in which the long-term are policy
will pay/provide benifits.
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Benefit
Period — The maximum length of time for
which benefits will be paid. Period of time that
begins when the insured becomes eligible for benefits
and ends when the insured is out of claim status.
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Benefit
Trigger — Criteria used to determine eligibility
for benefits. Triggers may be based upon limitations
in ADLs and/or degree of cognitive impairment.
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Elimination
Period — The number of days the insured
must receive qulifying care before the policy will
start paying benefits. Typically elimination periods
are 30, 60 or 90 days.
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Long
Term Care — Medical, social, and/or personal
care services required over a long period of time
by a person with a chronic illness or disability.
Services are designed to help the person maintain
as much independence as possible and may be provided
at home, in the community or in an institutional
setting.
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Medicaid — (Title
XIX of the Social Security Act) A federally funded,
state managed program of medical aid for persons
of any age who are unable to afford regular medical
services. In California, Medicaid is referred to
as Medi-Cal. Both are part of the national and state
sponsored welfare program.
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Medicare — (Title
XVIII of the Social Security Act) A national health
insurance plan for people over the age of 65 and
for some people under the age of 65 who are disabled.
It includes two parts; Part A covers hospital costs
and a limited amount of skilled nursing care; Part
B is the supplemental portion for which the insured
pays premiums covering a portion of the physicianĂs
fee as well as the various types of therapy.
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Outline
of Coverage — Brief description of important
features of a policy, including benefits and limitations,
delivered at the time of solicitation.
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Severe
Cognitive Impairment — Defined as a loss
or deterioration in intellectual capacity that
is similar to Alzheimer’s disease and like
forms of irreversible dementia and is measured
by clinical evidence and standardized tests that
reliably measure impairment in short-term or long-term
memory, orientation to people, places or time and
deductive or abstract reasoning (ISR Ruling 97-31,
May 1997).
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Waiver
of Premium — Provision that ensures that
insurance will remain in force under certain circumstances,
when the insured stops paying the premium while
benefits are being received.
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