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What To Look For When Purchasing A Long Term Care Insurance Policy

The Trigger For Qualifying For A Benefit

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Policies define eligibility for benefits differently. Common variations are:

  • Your doctor prescribes specific care. (This is ideal).
  • The care is required because it is "medically necessary for sickness and injury."
  • The care is needed because of a cognitive (mental) impairment.
  • The care is required because you are unable to perform a described number of activities of daily living such as bathing, dressing, walking, transferring from bed to chair, toileting and eating, or because of limitation in mental function. (As a general matter, policies require that the policyholder needs to demonstrate that he or she required help with at least two activities of daily living).
  • A requirement that you be hospitalized for at least three days prior to the need. (This is the requirement used by Medicare for skilled nursing benefits).

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