Long-term care insurance (LTC) is defined as a variety of medical and support services for people who, due to chronic illness or disability, need human assistance with ordinary activities, such as bathing or dressing, for extended periods of time. This is not just coverage for older individuals; it is anyone who has lost some or all capacity to function on their own due to an accident or chronic condition.
Generally, LTC provides coverage for skilled, intermediate and home health care. Some plans may include coverage for adult day care coverage. Plans are typically designed to pay a specified dollar benefit or a percent of expenses to a maximum for the care being received.
Eligibility typically includes employees and their spouses, and may also include coverage for their parents. This will vary by plan, so consult the insurance company.
An individual becomes eligible for benefits when his/her doctor certifies that a loss of capacity has occurred. This may be due to either illness or injury. The loss must require human assistance in performing two or more Activities of Daily Living (ADLs) as defined in the policy. Typically, the ADLs are bathing, dressing, mobility, toileting, and eating.
