As a geriatric care manager, I am sometimes asked to help families throughout Westchester County, initiate their long term care (LTC) insurance claim. I am happy to assist in this endeavor. But if truth be told, and I consider myself a truthful geriatric care manager (except for my necessary fiblets, see June 12, 2012 blog), I sometimes wonder why families wait so long to open these policies. Do you really want to continue to pay those exorbitant premiums? Just a reminder, once the claim is approved and the elimination period has been reached, one stops paying the premium. So what are you waiting for?
My experience has taught me that families wait because they don’t know it’s time to begin. And how do you know it is time to begin? For starters, one should have a copy of his/her policy. It will outline the elimination period, the daily benefit amount, services available, what disabilities must be present and the places in which services can be paid for. Benefits are rendered at home using a home care agency, in an assisted living facility, a day care program or a nursing home. A diagnosis of dementia is usually an automatic trigger that opens the policy. Needing assistance with two of the six activities of daily living: eating, dressing, bathing, transferring, toileting and incontinence is another trigger to get the policy going.
Once you recognize that one of these triggers is present, a call to the long term care insurance company should be made. A benefits analyst will be assigned to you. A rather thick envelope will arrive with a slew of papers to be filled out. You will have to provide the insurance company with a Plan of Care. This form is filled out by the claimant’s physician. The LTC insurance company will then send out their own nurse to do an evaluation. Documents will be reviewed, and a decision made.
So what can be the worst that can happen if you endeavor to open a claim? Rejection. However, all is not lost. You will have gained a familiarity with your policy and will get a better idea when the time is right. If you excuse this geriatric care manager’s inventive analogy, it’s like having a cataract. The ophthalmologist will tell you when the time is “ripe” (their medical term, not mine) to have it removed. The same is true for initiating a LTC insurance claim. The right time will come. And the only thing that will be removed are those costly semi-annual premiums. A win-win situation.