How do I Satisfy my Policy's Deductible and become Eligible for Claims Payments?


In answering the previous question, we touched upon this. It is important to understand exactly how your policy works.


Here is what to look for relative to the elimination period (deductible):


Does the policy use a calendar day elimination period (EP, or do they use what is referred to as a service day approach? Here's the difference. If you have triggered benefits by ADL loss or cognitive impairment, a calendar day EP means that, once that number of days has passed, you are eligible trigger claims payment, whether or not you have received care on any of those days, or paid for care on any of those days. In contrast, policies that have a service day approach towards the EP only count those days on which you receive eligible professional (paid) services against the EP. In other words, if your policy has a 90 day EP, and, in the first 90 days of your claim you only paid for 20 days of professional care, your EP would be satisfied under a calendar day EP policy, but you would be 70 days short of satisfying a service day EP.


What to look for in terms of covered/eligible services: Is care my unlicensed (or licensed!) family and friends give ever eligible for claims payment?


Do licensed professional caregivers also have to be employed through an agency, or if they are licensed but self-employed, will that suffice?


The answers to all these questions are in the policy.


If your policy doesn't cover the kind of care that you are looking for, keep in mind that it may be possible to negotiate with the insurer on a claim if the request is a win-win for you both.


Go back to frequently asked questions - help with long term care insurance claims