We have had a LTC Policy and I called them and asked about when does the policy kick in. They told me that I have to pay out of pocket for 60 days of care in a 6 month period. They also so said that she had to meet the 2 out of 6 Activity of Daily Living. That was the hold up, she does not meet that requirement. I was wanting to start as soon as possible in that we had paid a lump sum for the policy 8 yrs ago. I went back and read the policy again. It said that it covers AD. I was wonder why would they put that statement in the policy if you still had the 2 out of 6 ADL requirement. I called the claims department and asked for a clarification. I was put on hold and and left a message on voicemail what I was wanting clairifacation on. They never called back, that was last week. I sent an email to the company on Monday and did not get a response. I then decided to call again this morning. They knew about my call but stated they had 5 days to return the call. Long story short, she does not have to meet the 2 out of 6 if she has AD.
Glad you got clarification and that she's "in." Disappointed in company responses - or lack thereof. You'll probably have to keep their feet to the fire the whole journey, but I hope not.
I agree with Zibby that the responses from the company are disappointing. I'm glad it worked out for now and hope they are more cooperative in the future.
Thanks for the heads up on this. While my DH does not have the LTC plans..he was diabetic when we got one for me and it was too costly ( who knew??), there may be other situations like this where we have to hold feet to the fire...
Great news Bob! I'm glad things worked out for you! I don't have a LTC policy for DH....I'm finding I am so unprepared for the turn my life has taken, it's really scaring me!
Yes, I am glad I asked for them to clarify. She will qualify under the cognative impairment clause. I have a person to interview in the morning. The policy also pays fer 21 days a yr respite care but I am not sure how that works, I guess that is in addtion to the regular care.
I wish I had asked 2yrs ago when she was given SSD.
Bob, most LTC plans state they will begin coverage if the client cannot perform ADLs (some are 2 some are 4) or require supervision for cognitive impairment. DH can still perform all ADLs but requires supervision due to cognitive impairment, so he gets LTC coverage. Which company holds the LTC coverage? DH's is John Hancock. Read the policy carefully...in our case they pay up to $112.00/day for in home care but they have specific requirements regarding the qualifications of the person providing care or the supervision of the person providing care (ie non-skilled person under the supervision of an RN). Good luck...it's complicated.
The care has to be by a state licensed care provider. I will be charged $15.00 per hour/ 4 hour min. I have to pay out of pocket for 60 days of care then they will pay $2700.00 max per month any way I want to use it for the rest of her life.
We also have John Hancock, and it has been a hassle just to get the acceptance of the caregiver service to put towards the elimination period (90 days). I can only manage one four hour respite a week, so it is not adding up very quickly. After paying for this for 10 years, it is frustrating to say the least. There are lots of small print items also.
We had GE which became Genworth. After we met the 90 qualifying days they paid everything-no cap on length of years. All they asked was a yearly update from the facility and that their nurse do a yearly eval.
Does it make any sense that you have to ask the company that is obligated to pay, what they will pay. The policy is written in such a manner that you need to be a lawyer and a doctor to interput what they say they will do. Then you have to depend on their claim department to tell you what it means. I would like to see a 3rd party to tell you what the policy should pay based on the policy and the 3rd party has nothing to benefit. Where is the consumer protection in this mess?
Bob, obviously they do that deliberately. I asked our elderlaw attorney to review the policy so I really understood the benefits and I an an HR professional with 25 years of experience in benefit plans!