Glossary

Alternate Level of Care

Alternate level of care is care received in a hospital inpatient setting for those persons waiting to be placed in a nursing home or while arrangements are being made for home care.

Guaranteed Renewable

Guaranteed Renewable means the individual policy must be continued in force by the insured through the timely payment of premiums, and the insurer has no unilateral right to make any change in any provision of the individual policy while the insurance is in force. The exception is that premium rates may be revised by the insurer on a class base. The insurer cannot decline to renew the individual policy as long as the insured makes timely payment of premiums. Also as long as the individual policy was delivered or issued for delivery in New York State, the insurer cannot change the premium rates on a class basis without the approval of the New York State Department of Financial Services.

Care Management

Care management is a unique benefit of Partnership policies. Each Partnership policy offers a minimum of two, face-to-face care management consultations per calendar year (in addition to information and referral services offered by insurers) by independent professionals experienced in the field of long-term care, after insureds are authorized to begin receiving benefits.

The purpose of the care management benefit is to provide an independent source of review of a policy- or certificate-holder's individual situation and advice on the optimal use of insurance benefits and other available long-term care services in an insured's community. This benefit is reimbursed up to the amount of the nursing home daily benefit included in the Partnership policy selected and is deducted from the lifetime maximum benefits when used.

For example, if an insured person purchased a policy with a $200 per day nursing home benefit, he would be able to access care management benefits up to $400 per calendar year during his coverage period ($200 x 2). In this example, the care management consultations cost only $100 each, then the individual would be able to access the care manager for consultation a total of four times since he can be reimbursed up to a total of $400 per calendar year. In this example, his lifetime maximum benefit would be reduced by two nursing home benefit days if he used $400 in total care management reimbursement.

Combined Home Care Benefit

Combined home care benefit permits the combining of home and community-based care benefit days to pay an amount in excess of the daily benefit amount for home and community based care benefits set forth in the policy. When this benefit is provided in the policy, the combination of benefit days shall result in no more than the equivalent of 31 days of home and community based care benefits being paid at the home and community based care daily benefit amount in any one month period.

Independent Provider Benefit

Independent provider benefit is a home care benefit under a plan of care that is provided by a provider who is either officially trained or certified as a home health care provider, or licensed as a health care practitioner. However, the provider need not be affiliated with an entity licensed or certified by the jurisdiction where the provider is rendering home care benefits.

Waiver of Premium

Waiver of premium is a policy benefit that waives the payment of premiums after care has begun. This benefit may be offered at an increased premium charge. The period, when waiver of premium begins, and for what specific type of care, such as nursing home care, residential care facility, home care, or community based services, are specified in the individual policy. The policy should be examined to determine the requirements for waiver of premium.

Partnership for Long Term Care

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