We each have a John Hancock Long Term Care Insurance policy. I have not yet done anything with DH's coverage but want to get started on qualification and finding home care to start the 90 day elimination period. According to the policy one or two days of Home Health Care in one calendar week will count as 7 calendar days against the 90. Go figure. (READ EVERY WORD OF YOUR POLICIES)
To qualify for benefits it states:
"You must receive care or services that are consistent with Your care needs and are covered under this policy, specified in a PLAN OF CARE and are in accordance with accepted medical and nursing standards of practice."
"You must submit to Us a current PLAN OF CARE and written Proof of Loss that is acceptable to us."
The Plan of Care is defined as being a plan written especially for him and must specify the type, frequency and providers of all the services he requires .... A Licensed Health Care Practitioner must approve your Plan of Care.
So, my question is do any of you have this requirement? The policy also pays up to $2,120 per year for "Care Advisory Services" by a Home Health Agency, Care Management Organization, or Independent Care Manager.
Looks like I need to find us a Care Manager of some sort and get a Plan of Care. We are in a small town. I think I can find an organization in nearby area to see about this. Any pitfalls to watch out for? I feel like I need someone who advise me on the use of this coverage as well as to provide the plan needed to begin coverage. The Home Health Care coverage alone specifies several different types of licensed people we might use and since DH is probably stage 5 now he doesn't have any physical requirements yet.
"You must submit to Us a current PLAN OF CARE and written Proof of Loss that is acceptable to us."
We don't have a LTC policy; so can't help you, but based on your comments and others, seems like they have to be reviewed closely so you'll know what's acceptable to them.
What I do not like about LTC insurance is that you are dependant on the Insurance Co. to do the right thing. It seems like there should be some agency that oversees that the insurance Co. is doing the right thing. Other wise you have to sue them to get what you thought you were buying. There is too much left for them to interrept and hopefully in your favor. It just seems odd to pay for something where you really are not sure of the fine details and you can not figure it out for yourself if you read the policy because of all the legal terms. In your case what is it that they want to see in the care plan that will be acceptable to them. Do they have a list of care needed based on the stage or condition of your spouse? It just seems open for them to provide the least amount of care possible when you wanted and thought you were getting was something better.
they're very clear on what they will provide and it looks to be a very good policy paying up to $212 per day now with 5% inflation clause for either in home or asst liv/nursing home. We showed it to a financial advisor 3-1/2 years ago before we moved from Northern VA to Northwest AR. He said it was the best he had seen and he also advised that we start using it as soon as possible to start the elimination period. I just haven't been able to deal with this until now but since we paid pretty high premiums in order to get unlimited coverage there's no reason not to use it now.
I also have John Hancock LTC..the elimination (read deductible) period takes forever ...I have been working on it for a year and am no where near to reaching the 90 days. They did use the changes to our home ( grab bars, railings etc.) as admissible items, but it will be forever before we qualify for the 90 days. I can only manage one 4 hour stint a week normally, and that takes a VERY long time. Very frustrating.
Kathi, our policy states that "one or two days of Home Health Care in one calendar week will count as 7 calendar days against the 90 days." Given that we would be able to use in home care once or twice a week for only 13 weeks to reach the 90 days. If we wait until DH is placed in the I hope distant future we would have to pay for the entire 90 day charge. The financial advisor clued us into this provision in the policy so we wouldn't think we actually had to have 90 days of in home care first.
I also have John Hancock LTC with the 90 day elimination period, 5% inflation per year and it’s a life time policy of care. To get it started I called them to initiate a claim. They provided a nurse to come to our home to interview my wife and the nurse submitted the care plan to John Hancock. I then had to submit to them (over the phone) the day care provider name and contact and the in home provider name and contact for approval before starting those services. I started these services last May and used the minimum service per day to meet the 90 day elimination period which was satisfied sooner than I expected about one month ago. John Hancock is a great company to deal with and I’ve heard from others that they are the best. They certainly made the whole process easy for me. I purchased the LTC policies for my wife and myself 13 years ago so the premiums are very reasonable. Also, all future premiums are waived if the insured person is in a care facility.
I think we have a bare bones policy, and do recall having in home help 3 or more days a week counts as one week, but I am not able to do that. It is tucked away in the safe, but will double check it. The beginning process was anything but easy for me..depends on what represetataive you speak with, I'm sure. I was beyond frustrated for the first two months. Our policty only allows for three years in a care facility. My husband took this out ten years ago, and I never saw it until he was DX...self inflicted wounds, of course, it was too late to adjust by then.
Terry--My husband's long term insurance company has obtained all the information they have needed directly from his doctors, the daycare program, and the home health agency. My advice would be to call the insurance company and ask them to explain how it all works. As per Jerry's experience above,they have asked for minimal information from me--they have done all the work of actually gathering the information. They could not have been nicer and more responsive to my needs. I wouldn't start by spending money on a care manager, etc., solely for the purpose of using the policy--it may not be necessary. I agree that reading and understanding every word of the policy is critical.
Terry, DH has JH as well but his policy was through his former employer and not as "robust" as the one your DH has. I called JH and notified them that DH would be needing a live-in due to his condition. They required him (or me as POA) to sign release forms so they could get all the medical information from his doctors to determine if he qualified. Because we had already engaged a Home Health Care agency, we had a plan of care which they developed (nurse interviewed DH) to give to JH. But BEWARE and read the fine print and if you don't understand the policy provisions, have an elder law attorney review and explain to you; it will be money well spent. Oh by the way, JH investigated us claiming that I knew DH had memory problems and deliberately withheld medical treatment so he could qualify for the LTC policy. Their theory was totally false (and ridiculous, I might add) but I had to engage an attorney to deal with them and get them to start paying on the policy.
Okay, called a Home Health Care Agency (cost $15.00 BTW). They thought John Hancock should send them claims form so I called Hancock at their request and they said to go ahead and start the care and then send in the info and they will contact the agency. They know I'm paying out of pocket working on the elimination period. I posted on another thread a question about what I should tell DH when the R.N. comes out to evaluate him before they start sending someone. I think I'll just tell him the truth and focus on our getting rid of the more than $200 per month premium charge which will be waived after we meet the 90 day elimination.
sheezzz.....i hate this kind of stuff......but thank god we have this policy. We've had such severe financial hits the past few years I can't believe we're catching a break here.
Terry, this is where a fiblet comes in handy. You don't want to upset him, you don't want him to worry about money or that he is being a burden to you where you need help. I responded to you on the other thread in more detail. Good luck!