Long-term Care Insurance: Risks to Consumers Should be Reduced |
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27 policies 44 policies 89 percent lapse absence of uniform ADLs adopted NAIC standards agent commission allow insurers allow their policies Alzheimer's disease cognitive impairment coverage criteria for determining definitions for levels determining eligibility eligibility criteria eligibility for benefits establishing minimum standards example first-year commissions grievance process health care benefits home health home health care improved significantly increase premiums inflation protection insurer expects invested in premiums key NAIC standards long-term care insurance long-term care policies long-term care services marketing abuses medical necessity Medicare Medigap insurance Medigap policies meet NAIC standards NAIC established NAIC standards developed nursing home residents policies contain definitions policies that offer policies to lapse policies we reviewed policyholders will allow prior hospitalization Private Long-Term problems purchase long-term qualify for benefits recent NAIC standards reducing the number regulations regulatory standards requests for price Requiring that policyholders sales agent standards for long-term term care insurance typically offered uniform definitions
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Page 9 - One policyholder learned that the insurer would not provide benefits unless he received care in a nursing home that maintained a daily medical record for each resident.
Page 1 - Private long-term care insurance policies typically offer indemnity benefits for nursing care.3 That is, these policies pay a set amount each day for a specific period of time a policyholder receives care. A policy may or may not cover all types of long-term care, and different policies may define covered long-term care services or facilities differently. In addition, many policies also cover home care services. Traditionally, states have had the primary responsibility for regulating the insurance...
Page 15 - ... premiums on existing policies. Insurers can thus transfer from themselves to aging policyholders a substantial portion of the risk associated with long-term care insurance; that is, insurers who incur more claims than expected can simply increase premiums. Premium increases can place policyholders at risk of being priced out of the market at the time when they are at greatest risk for needing long-term care services. The risk of future premium increases may be significant, given that some insurers...
Page 23 - HIGH QUALITY PRIVATE LONG-TERM CARE INSURANCE: CAN WE GET THERE FROM HERE?
Page 20 - While states have progressed in recent years in adopting longterm care insurance regulatory standards, many do not conform to the standards suggested by NAIC and future state action is unclear.
Page 10 - Many insurance companies use eligibility criteria that require that care be "medically necessary." But some policies do not define the term. Of the 30 policies that required care to be medically necessary, 6 left the term undefined. For the other policies, the definition varied. Apart from problems with the definition of medically necessary, medical necessity is not a relevant criterion for policyholders who do not need medical services.