Policy Benefits

Chances are you know someone who has needed long term care services. Maybe you’ve been a caregiver yourself.

Your long-term care policy is designed to help you get the long-term care services you need in the setting that right for you – whether at home, in an assisted living facility or in a nursing home. *

So many questions. Associates of Clifton Park can help answer them. A long term care insurance policy may provide funds to help pay for services you require so you can:

  • Balance help received from family members with professional caregiving services.
  • Get the care you need while staying in your own home for as long as possible.
  • Protect part of your retirement nest egg from the cost of long term care.

Policies can be tailored to cover varying circumstances. They are not one size fits all. When deciding which coverage you’ll need, here are some things to consider:

  • How much can you afford to contribute toward the expense of your care?
  • For how long might you need long term care services?
  • How much time will elapse before you need to start receiving benefits from the policy? What’s the anticipated cost of long term care? (Ask your representative what care generally costs in your area)

* Your location of care is determined by a licensed health care practitioner that provides a plan of care.

UNDERSTANDING YOUR POLICY

When the need for care first arises, you’ll probably turn to family members or friends. However, your needs may go beyond their ability to help – whether physically or financially. That’s where your MutualCare® Secure Solution policy comes in.

Policy Limit – This is the initial maximum amount payable over the life of the policy. The policy limit is calculated using the benefit multiplier and monthly benefit you select.

Monthly Benefit – This is the initial maximum dollar amount your policy will pay each month.

Calendar Day Elimination Period – Your policy has a waiting period before policy benefits begin. The elimination period starts on the first day you are chronically ill and you receive a covered service. Once the elimination period has been satisfied, benefits for covered services are paid to you each month, up to the maximum monthly benefit you select.


POLICY BENEFITS

Home Health Care – Benefits are provided to help you stay at home as long as possible. These include:

  • Personal care services to assist with the activities of daily living
  • Homemaker services to provide help with grocery shopping, meal preparation and housekeeping
  • Professional services of a registered nurse, home health aide or therapist
  • Adult day care services

Residential Care Facility – Sometimes, more care is needed than can be provided at home. Should this happen, your policy also covers assisted living and nursing home care, up to 100 percent of your monthly benefit. The policy even will pay to reserve your bed in a facility for up to 30 days per calendar year should you need to leave the facility for any reason.

Care Coordination – Finding long-term care services may seem overwhelming. So we give you access to the services of a care coordinator – a licensed health care professional who will assess your needs, develop an individualized plan of care and help you arrange for long-term care services. There’s no elimination period to satisfy for care coordination services, and use of a care coordinator makes you eligible for additional benefits designed to help you remain safely in your home, including:

  • Caregiver training
  • Durable medical equipment
  • Home modification
  • Medical alert system

Respite Care – Unpaid caregivers often need a break. So your policy provides short-term relief by including a benefit to hire a temporary replacement for up to one month per calendar year. No elimination period is required to receive this benefit.

Hospice Care – If you are terminally ill and not expected to live beyond six months, your policy will pay for hospice care received in any setting. No elimination period is required to receive this benefit.

International Benefit – If you’re traveling outside the United States, Canada or the United Kingdom when the need for care arises, your policy will pay the maximum monthly benefit of your policy for up to 12 months for covered long-term care services you receive.

Waiver of Premium – We don’t want you to worry about paying premiums when you are receiving care, so we waive premiums while you are receiving the cash benefit or covered home health care services at least eight days in a month or assisted living or nursing home services.

Alternate Care – We know there may be long-term care services or treatments that don’t exist today yet may become standard practice in the future. Your policy may pay benefits for qualified treatments or services not specifically listed in the policy when recommended by your care coordinator.

Cash Benefit – Electing to receive policy benefits in cash may be a helpful strategy as you develop a permanent plan of care. There’s no elimination period to satisfy. No bills to collect and mail for reimbursement. You can simply use the cash to pay for services to support your plan of care. Your cash benefit equals:

  • 30 percent of the policy’s home health care benefit

The cash benefit pays up to an initial maximum of $2,400 each month. This amount may increase if an inflation protection benefit is added to the policy.


OPTIONAL BENEFITS **

Inflation Protection – The cost of long-term care services is likely to be higher down the road when you need care. So you have the option to add an inflation protection benefit, which increases your maximum monthly benefit and remaining policy limit each year.

Shared Care – If you run out of benefits but still need care, you can access benefits under your partner’s identical policy, providing you leave at least one year of benefits for your partner. In addition, if either partner dies while both policies are in force, the surviving partner receives the deceased partner’s remaining policy limit without having to pay the deceased partner’s premium.

Waiver of Elimination Period for Home Health Care – This allows you to begin receiving home health care benefits immediately with no elimination period to satisfy. Once home health care benefits begin, your elimination period for nursing home and assisted living will begin to be satisfied on a calendar-day basis. This means days in which the elimination period is waived for home health care or adult day care will be used to satisfy the elimination period for other benefits available under your policy.

Reduced Benefit for Home Health Care and/or Assisted Living Facility – Your policy will pay up to 100 percent of the maximum monthly benefit for home health care and assisted living facility care. However, if your primary concern is paying for nursing home care, you have the option to reduce your benefits for home health care and/or assisted living services. Keep in mind that reducing your benefit for home health care also reduces your cash benefit proportionally.

Return of Premium Three Times Monthly Maximum – If you’re concerned about not using all your policy benefits, you can add a return of premium benefit that, upon your death, refunds up to three times the initial monthly benefit amount of your policy, as long as your policy has been in force for 10 years or more. This amount excludes claims paid by the policy and any inflation increases. If coverage is decreased, premiumreturned will be based on the decreased amount.

Non-Forfeiture Shortened Benefit Period – If for any reason you stop paying premiums after your policy has been in force for three years, this allows for your coverage to continue on a reduced basis.

**The Optional Benefits can be added for an additional premium