Glossary of Long-Term Care Terms
You will need to know what is meant by certain terms used to describe your benefits under the Group Long-Term Care Plan. Many of these words are defined below.
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Means work on a regular full-time or regular part-time basis (20 or more hours per week) at one of the Company's business locations or in a location where you are required to be on the Company's business.Return to the Index.
Means certain basic daily tasks necessary to maintain a person's health and safety.Return to the Index.
Means U.S. Care, who has been chosen to administer a Group Long-Term Care Plan on its behalf.Return to the Index.
Means a program for six (6) or more individuals, of social and health-related services provided during the day in a community group setting.Return to the Index.
Means a facility which provides Adult Day Care and, in those states that license Adult Day Care, is licensed or certified to provide Adult Day Care.Return to the Index.
Means a facility that primarily provides services sufficient to support needs resulting from an inability to perform Activities of Daily Living or Cognitive Impairment to at least six (6) residents in one location and meets all of the following criteria:
May include any of the following types of facilities:Return to the Index.
Means care provided in an Alternate Facility.Return to the Glossary Index.
Means the payment you receive for room charges in a Nursing Facility or Alternate Facility (to reserve your bed) when you are temporarily hospitalized while receiving benefits.Return to the Index.
Means a period of twelve months that begins on January 1 and ends on December 31.Return to the Index.
Means a health professional designated by U.S. Care to perform your Long-term Care assessment and prepare your Service Plan.Return to the Index.
Means the payment for services of a Care Advisor.Return to the Index.
Means a loss of mental capacity demonstrated by a person's inability to think, perceive, reason or remember. Such impairment:
Determination of Cognitive Impairment will be made by U.S. Care on the basis of:Return to the Index.
Means a person who is in the Eligible Group and approved for coverage under the Group Long-term Care Plan.Return to the Index.
Means the Consumer Price Index for all Urban Consumers published by the United States Department of Labor.Return to the Index.
Means that level of care which is mainly for the purpose of meeting the Activities of Daily Living.Return to the Index.
Means the day upon which your coverage under the Plan starts.Return to the Index.
Means a plan of Long-term Care services prepared by the Care Advisor for which no benefits are payable under the Plan. This plan will be arranged for you when benefits provided by the Plan are about to end due to your Maximum Lifetime Benefit.Return to the Index.
Means the 45 days following the date the Premium payment is due. Although coverage will continue in force during the Grace Period, it will terminate retroactive to the last day through which Premiums are paid, if Premiums due are not paid within the Grace Period.Return to the Index.
Means care provided to a person in his or her home which is mainly for the purpose of meeting the Activities of Daily Living. It may be rendered by persons without professional skills or training working under the supervision of a Home Care Agency or a Home Health Care Agency; however, this does not include a member of your Immediate Family.Return to the Index.
Means an agency or organization which provides Home Care, and:Return to the Index.
Means a program of professional, paraprofessional or skilled care provided through a Home Health Care Agency to a patient in his or her home.Return to the Index.
Means an agency or organization which provides Home Care or Home Health Care, and:Return to the Index.
Means an institution, operating within the scope of its license when rendering services in treatment of a condition for which claim is made, that is:Return to the Index.
Means a Covered Person's Spouse, daughter, son, father, mother, sister or brother, granddaughter or grandson, or in-laws.Return to the Index.
Means a degree of nursing care and evaluation that is less than that provided for Skilled Nursing Care, but greater than that provided for Custodial Care. This level of care provides a planned, continuous program of nursing care that is preventive or rehabilitative in nature.Return to the Index.
Means services that are provided in a setting other than an acute care unit of a Hospital. In the Group Long-term Care Plan, "Long-term Care" includes Skilled Nursing Care, Intermediate Care, Custodial Care, Nursing Facility Care, Alternate Facility Care, Home Care, Home Health Care, Adult Day Care, and Respite Care.Return to the Index.
Means the maximum benefit allowed per day as shown in the Schedule of Benefits. The Maximum Daily Benefit will not exceed the daily rate actually charged for the care received in a Nursing Facility or Alternate Facility.Return to the Index.
Means the maximum amount of benefits that will be paid for a Covered Person under this Plan during the covered person's lifetime. This benefit limit applies to any combination of Long-term Care services for which a benefit is paid under this Plan.Return to the Index.
Means the maximum benefit allowed during a given month for any combination of Home Care, Home Health Care, and Adult Day Care, as shown in the Schedule of Benefits. The Maximum Monthly Benefit will not exceed the actual charges for all covered services received during the month.Return to the Index.
Some policies also allow medical necessity as a qualifying criteria. This usually means that your doctor has certified that your medical condition will deteriorate if you do not receive needed services in a setting such as a nursing home or your own home. In this instance needed services are identified by your doctor in a Plan of Care.Return to the Index.
Means all parts of the Health Insurance for the Aged Act under Title XVIII of the Federal Social Security Act.Return to the Index.
Means:Return to the Index.
Means a legally qualified person, other than a member of your Immediate Family, who is licensed by the state as either:Return to the Index.
Means a facility or part of a facility that is licensed or certified in the state in which it is operating to provide Skilled Nursing Care, Intermediate Care, or Custodial Care.
Nursing Facility does not mean a Hospital or an institution that is operated mainly for the treatment and care of:
Means care or treatment received in a Nursing Facility. It includes Skilled Nursing Care, Intermediate Care, and Custodial Care.Return to the Index.
Means a period of time, after the Wait Period, during which you are receiving Long-term Care due to (a) an inability to perform two or more Activities of Daily Living; or (2) a Cognitive Impairment.Return to the Index.
Means the provision of hands-on services to assist an individual with Activities of Daily Living (such as bathing, eating, dressing, transferring and toileting).Return to the Index.
Means the monthly amount payable to the Group Long-term Care Plan by a Covered Person.Return to the Index.
Means a population segment classified by actuaries as having similar coverage risks.Return to the Index.
Means short-term care which is:Return to the Index.
A long-term care policy may reinstate benefits you have used, after you have stopped needing care for a prescribed number of days. For example, if you have a 3-year policy, receive benefits for one year, then do not require care for six months, the policy then gives back the year and you have 3 more years of coverage. If a policy offers restoration of benefits, check to see what percentage of the benefit is restored and how long you must be free of treatment for benefits to be restored.Return to the Index.
Means a schedule of benefit coverage that is provided to each Covered Person which establishes Premium amounts, Premium payment mode and a summary of the benefits and limitations that apply.Return to the Index.
Means a written description of the Long-term Care services appropriate to meet your needs.Return to the Index.
Means that level of care which:Return to the Index.
Means the number of days of eligible, covered Long-term Care services which must be received before benefits are payable under this Plan. The Wait Period can be met by any combination of eligible, covered Long-term Care services (except Respite Care Benefits and Care Advisory Benefits) described in this Group Long-term Care Plan. The services need not be continuous but must be received during a period of 12 consecutive months.Return to the Index.
Means a Premium amount paid by you for coverage that extends over a period of time during which your coverage is no longer in force.Return to the Index.
End of Glossary.
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