A B C D
E F G
H I J K L
M N O P
Q R S
T U V
W X Y Z |
A |
Activities
of Daily Living (ADLs) |
The basic activities
and functions performed on a daily basis that are usually
done without assistance. The six ADLs are:
-
Eating
-
Dressing
-
Bathing
-
Toileting
-
Transferring
-
Continence
|
Accumulation
Period |
The pre-determined
amount of time that must pass before the benefits are
to go into effect for the claimant. |
Accreditation
|
A formal
recognition by an impartial and independent organization,
which confirms that a particular insurance company is
upholding the standards of the industry. |
Actuary
|
This person
is professionally trained in the specifics of pensions,
insurance and related areas. They determine how much money
must be contributed to an insurance or pension fund in
order to be sufficient for the future. |
Additional
Insured |
An insured
person specifically stated in an insurance policy
|
Adjustable
Life Insurance |
A type of
insurance that allows the holder to change the terms of
the insurance, raise or lower the face value of the policy,
increase or decrease the premiums and/or the time period
of the policy |
Adult
Day Care |
A daily program
made up of social and health-related services provided
daily outside the home in a group setting to support weak,
elderly, or other adults with impairment |
Advantage
List |
List of health
service providers that agree to give particular insurance
company policyholders a preset discount |
Age
Limits |
Stated minimum
and maximum ages below and above that the insurance company
will not accept policy applications |
Agent
|
A licensed
insurance company representative who sells, negotiates
insurance policies, and provides service to the policy
holders |
Alien
Insurer |
An insurance
company located in another country |
Allocated
Benefits |
Benefits
that have a stated maximum amount payable for specific
services itemized in the contract |
Alzheimer's
Care Center |
A treatment
center that specializes in providing care for those with
Alzheimer's Disease with more of the care geared towards
supervision of the patient in a safe and controlled environment
|
Alzheimer's
Disease |
A degenerative
disease of the brain which attacks nerve cells in the
cortex of the brain thereby impairing a person's abilities
to think and function |
Amendment
|
A formal
written document signed by both the insurance company
and the policyholder, which changes the terms of the insurance
policy |
Application
|
A signed
statement of facts filled out by the person applying for
the insurance policy, which is then used by the insurance
company to decide whether or not to issue a policy. The
application then becomes part of the policy |
Assessment
|
Determination
of the person's level of physical ability or mental capability,
and the type and extent of services available and needed
|
Assignment
|
The legal
transfer of one person's insurance policy to another person
|
Assisted
Living Facility |
A facility
which provides 24 hour around the clock care to resident
patients in need of assistance with any number of the
Activities of Daily Living (ADLs). |
B |
Baby
Boomer |
A person
born between the years of 1945 and 1964. |
Bad
Faith |
A charge
against the insurance company that they have not acted
in a way that is consistent to the way a reasonable policyholder
would have expected. |
Beneficiary
|
The person
designated or provided for by an insurance policy's terms
to receive any benefits provided by the policy or plan
upon the death of the insured |
Benefit
Period |
The amount
of time an insurance company will make payments to the
individual to pay for care, etc after the deductible has
been satisfied. |
Benefit
Triggers |
Specific
situations that start payment of benefits |
Benefits
|
Money paid
by the insurance company to the claimant. |
Benefit
Limits |
An amount
that represents the daily benefit times the maximum number
of days you can receive for all benefits combined under
the policy |
Benefit
Options |
Each carrier's
insurance type generally has a set list of available benefits.
Each benefit comes with a price |
Binder
|
A written
or oral contract that temporarily places an insurance
policy in effect when it is not possible to issue a new
policy or endorse the existing policy immediately. The
binder must meet all the terms of the policy issued
|
Binding
Receipt |
A receipt
given for a premium payment with the application for the
insurance. If the policy is approved, this receipt binds
the company to make the policy effective from the date
of the receipt |
Board
and Care Homes |
Provides
seniors with a room, meals, and assistance with ADL's
and some supervision for their safety. These homes are
generally not certified by Medicaid, but are licensed
and approved by the State |
C |
Cancellation
|
Done either
by the insurer or insured, this discontinues the policy
before its normal expiration date |
Caregiver
|
The individual
who cares for someone with a disability or illness. The
primary caregiver is usually a spouse, child or other
relative. |
Care
Coordinator |
An individual
employed by the insurance company to handle all matters,
financial and otherwise, regarding the welfare of the
claimant for cost effective purposes. This includes, but
is not limited to, selecting physicians, specialists,
care centers, hospitals, etc. as well as coordinating
time periods of care |
Care
Line |
An informational
service that provides information on where to go for care
|
Care
Manager |
A trained
professional who is able to work with you and your family
and your doctors to assess your situation and determine
the appropriate Plan of Care. They will also help with
finding the available care resources |
Care
Plan |
This is a
written plan formulated by a health care professional
after an assessment has been done on the individual with
a chronic illness or disability. The plan provides a detailed
outline of the person's needs and what health services
are required to meet those needs |
Case
Coordinator Nurse |
This is your
contact person to discuss claims and benefits |
Cede
|
To transfer
all or part of the written risk to an insurer or to a
reinsurer |
Certificate
of Insurance |
A statement
given to the policyholder stating the insurance benefits
and terms |
Chronically
Ill |
A condition
that is verified by a physician that the renders the individual
unable to perform at least two of the Activities of Daily
Living (ADL's) for at least 90 days which requires the
individual to have Substantial Supervision to protect
themselves from threats to health and safety |
Claim
|
A submitted
request to the insurance company by the claimant to receive
payment and/or reimbursement for expenses incurred due
to disability, illness, etc. which are covered under said
policy |
Claims
Adjuster |
This is the
person who settles the claim, either an agent, company
adjuster, independent adjuster, adjustment bureau, or
public adjuster |
Cognitive
Impairment |
Loss of rational
comprehensive thought processes due to a degenerative
disease or disorder |
Commission
|
A part
of the premium that is paid to the policyholder's agent
or broker for their services in the insurance policy
process |
Commissioner
|
A state
officer who handles the state's insurance laws and regulations
|
Congregate
Housing Facilities |
Similar
to a dormitory setting, individuals have their own private
rooms, but often share meals. Care is generally
minor supervision to provide safety with emergency medical
assistance always available |
Contract
of Adhesion |
A contract
written by one party and signed or denied by another
with no chance of change to the terms stated within
the contract |
Compulsory
Insurance |
Any form
of insurance that is required under the law |
Concealment
|
Intentionally
withholding information on an insurance application
to hide facts from the insurance company |
Conservation
|
An attempt
made by the insurance company to prevent of the lapse
of a policy |
Consideration |
Acceptance by the insurance company of the payment of the premium
and the statement made by the prospective policyholder
in the application |
Contingent Beneficiary |
The person who will receive the benefits of a policy or plan if the main beneficiary
dies while the insured is living |
Contract |
A binding agreement between two or more parties stating specific terms and agreements. A contract of insurance is a written document
known as a policy |
Contract Holder |
The person, group, or entity, which the contact is issued |
Contract Law |
The part of civil law that interprets written contracts between parties and
resolves any disagreements |
Coverage |
The amount of protection provided under the contract of insurance |
Covered Nursing Care Facility (Confined) Benefits |
Policies that provided benefits for all levels of care will pay for benefits
in a nursing home that is licensed in the state in which
the claim is being made |
Custodial Care |
Non-medical care in which the patient receives help with their ADL's. Providers of this care do not need to be professionally trained
nurses or therapist. |
D |
Daily Benefit Period |
The length of time which your daily benefits cover |
Daily Benefit Rate |
The rate predetermined by your policy provider to cover your daily benefits |
Declination |
The refusal of an insurer to issue a policy based on the review of the application
for insurance and other relevant factors |
Deductible
|
An out-of-pocket amount of money that the insured must pay before the insurance
company assumes financial responsibility for the claimant's
expenses |
Demutualized
|
When shares of the company's stock are sold individually rather than part of
a large portfolio consisting of several individual stocks,
i.e. mutual fund |
Deposit
Premium |
This is the initial premium paid by the prospective policyholder when the insurance
application is filled out. This is generally equal to the first month's
premium and is applied towards the first month's actual
premium |
Discount Rate |
This rate is used to calculate the value of dollars paid or received in future
years to current dollars. For example, a dollar today may only be worth 50 cents
ten years from now. |
Doctrine of Reasonable Expectations |
A legal document that states policies must be written in such a way that a reasonable
person who is not trained in the law may interpret them |
Domestic Insurer |
An insurance company that is operates in the state in which they are incorporated |
E |
Effective Date |
The date on which the insurance policy begins |
Eldercare Locator |
A national hotline service that refers people to local services if you or someone
you know needs long term care. The number is 1-800-677-1116 |
Elimination Days |
A period of time between the initial need for care and the beginning of the
payments from the insurance company. |
Elimination Period |
The number of days that you have to pay benefits before your coverage begins
to pay for benefits |
Evidence of Insurability |
Statements or proof or a person's physical condition affecting the acceptance
for insurance |
F |
Fair Premium |
The premium level that is just high enough to cover an insurer's expected costs
and give insurance company owners a just return on their
invested capital |
Favorable Tax Treatment |
Benefits are received free from tax. Also, your premium and long-term care expenses may be deductible
from your Federal Income Taxes, within reason. Please contact your tax advisor for more information. |
Financial Counseling Programs |
Help seniors with managing their finances, bills, and completing Medicaid, Medicare
or insurance forms |
Financial Soundness |
Related to stability, it is important to compare the financial ratings and asset
of insurance carriers |
Foreign Insurer |
When the insurer is not located in the state in which they are incorporated |
Free-Look Period |
Once you buy a policy, most states allow you up 30 days to return your policy. Make sure to get written proof of this option when you receive your
policy |
G |
Gatekeeper |
Decided when a patient should be referred to a specialist or when particular
tests should be given |
Geriatrics Manager |
A person who assesses the needs of elderly people in terms of what services
they need, often arranges for these services and keeps
in touch with the person. The geriatrics manager is often hired by the person's immediate family
to keep them informed of the person's status when they
cannot be there themselves. |
Gross Premium |
The premium paid by the policyholder |
Guaranteed Rate Policy |
Written agreement stating premium rate will not increase over time |
H |
High Risk Individuals |
People who have a pre-existing health condition that have a greater than average
probability of future medical expense |
HIPAA (The Health Insurance Portability and Accountability Act of 1996) |
This act became a law on January 1, 1997. The act states the requirements that a long term care policy must follow
in order that the premiums paid may be deducted as medical
expenses and benefits not paid be considered as taxable
income |
Home Care Providers |
A person who provides home health care or hospice services and who meets the
following criteria
- Under the Medicare Program, has an agreement to be a provider of home health
care services
- Is licensed by their state as a home health care agency or hospice if licensing
is required in the state in which they are practicing
- Is a licensed therapist, a registered nurse (R.N), a licensed practical nurse(
L.P.N), or a licensed vocational nurse (L.V.N.) providing
services under the guidelines of their license
|
Home Care Services |
Household services done by someone else because you are unable to do them yourself. These include nursing services, personal hygiene, house
chores, errands, and preparation of meals, laundry and
small house maintenance. |
Home Delivered Meals |
"Meals on Wheels", provide meals to those who cannot cook for themselves |
Home
Health Aid |
Licensed individual that performs daily care for those in need of assistance
in their homes. Generally these people provide
help with basic daily activities such as bathing, eating,
and dressing |
Homemaker Service |
Generally in combination with a Home Health Aide, this person will cook, clean,
run errands, etc. |
Hospice Care Services |
Out patient services provided by a licensed hospice provider to help ease the
pain of terminally ill patients in their last stages
of their terminal disease. They also provide support
to the primary care giver and the family. |
House Claims Department |
Department that processes and reviews all claims |
I |
Immediate Family |
The person's spouse, children, parents, siblings, grandchildren or in-laws |
Incurred Services |
Received services from providers |
Indemnity |
Compensation to the claimant for disability or illness suffered - security against loss. |
Independent Agent |
A business person that represents two or more insurance companies in sales and
service and who is paid on a commission basis |
Independent Caregiver |
A person who provides home health care services or hospice care who:
- Is licensed to provide the care they are giving and are working independently
from a home health care agency. They must be licensed in the state they are
working in.
- Is chosen by You and has been qualified under the Independent Caregiver Certification
Benefit
- Is not a member of your immediate family living with you
|
Informal Caregiver |
Usually a spouse or relative, an informal caregiver is an unpaid individual
who takes on the responsibility of providing care for
the individual in question. |
Inflation Rate |
The rate, which the cost of long-term care is expected to increase in the future. Generally this rate is 1-2% higher than the overall U.S
inflation rate. |
Inflation Protection with the Automatic Increase Benefit Rider AIB |
A rider that helps you to keep up with the potential cost of your care due to
inflation. The rider increases your maximum daily benefit
either on a simple or compound basis, depending on the
rider you choose. |
Instrumental Activities of Daily Living (IADLs) |
Determines the physical and mental impairment while performing activities such
as shopping, telephone use, housekeeping, laundry, taking
medications, and managing finances |
Insurance |
A system of exchange under contract where payments over a period of time (premiums)
entitle individuals compensation by an organization
(insurance company) in the event of loss due to pre-specified
conditions. |
Insurance Carrier |
Insurance provider |
Insurance Commissioner |
The top insurance regulation official in the state |
Insurance Policy |
A legal contract issued by the insurance company to secure coverage for claimant |
Insurance Premium |
The pre-specified amount an individual pays to guarantee coverage for a policy |
Insured |
A person covered under an insurance policy, including any persons named as receiving
protection under the policy |
Insurer |
The insurance company that agrees to pay losses of benefits. Also, the insurer can be any company whose primary business is
selling insurance to the public |
Insuring Agreement |
The part of the insurance policy that specifies the promises of the insurer |
Insuring Clause |
A statement that specifies the type of loss covered by the policy and the parties
involved in the insurance contract |
Intermediate Nursing Care |
This care is provided to those who do not need care on a 24-hour basis. A skilled care person on a non-continuous basis provides the nursing
care. |
L |
Lapse |
The ending of the insurance policy due to the non-payment of a premium |
Lapsed Policy |
A policy, which has discontinued due to the non-payment of premiums |
Level Premium |
A premium that remains the same throughout the life of the policy |
Licensed Health Care Provider |
A doctor, or health care professional, who certifies every 12 months that you
are continuously ill and in need of support. |
Life Expectancy |
The average number of years of life remaining for a group of persons given age
according to a particular mortality table |
Living Will |
A written document, which states the wishes of an individual in advance concerning
the use of life saving devices and procedures in the
event that the person is terminally ill or has suffered
an injury and is no longer competent |
Long Term Care |
Care given in the form of medical and support services to persons who have lost
some or all of their capacity to function due to an
illness or disability. These services are generally provided away from the primary health
care facility and are of a long time frame. |
Long Term Care Insurance |
The insurance which pays for a succession of care giving services for the elderly
or chronically ill. This care may be provided in a facility
(nursing home, mental hospital, etc.) or in the individual's
home with a nurse or aide. |
M |
Maintenance or Personal Care Services |
Any care where he main reason for which the care is provided is to assist those
in need of care resulting from a chronic illness or
disability |
Married Couples Discount |
A plan that offers a reduced rate to those couples that apply for coverage and
are approved |
Maximum Lifetime Benefit |
The total amount Your carrier will pay you in Your lifetime for all benefit
provided under your policy. |
Medicaid |
Public assistance funded through the state to individuals unable to pay for
health care. Medicaid can be accessed only when all prior assets and funds
are depleted. |
Medical Help System |
A communication system set up in your home that is used to contact medical personnel
in the case of an emergency |
Medicare |
A Government program, administered by the Social Security Administration, which
provides financial assistance to individuals over the
age of 65 for hospital and medical expenses. Medicare does not cover long-term care expenses. |
Medigap |
Private health insurance that is used to pay costs not covered by Medicare,
such as deductibles and co-insurance |
Mode of Premium Payment |
The schedule of payment of premiums, monthly, quarterly, semiannually, or annually |
N |
National Association of Insurance Commissioners (NAIC) |
A national organization made up of state officials who are in charge of regulating
insurance. They have considerable influence and strive
to promote national uniformity in insurance regulations. |
Named Insured |
The first person in whose name the insurance policy is issued |
P |
Payment of Claim |
Timely payment, generally monthly after services have been given to patient
and the filed claim is proven valid |
Peril |
The cause of a loss, insured against in a policy |
Plan of Care |
A program of care and/or treatment that is set up with your licensed physician
and approved in writing before the start of care |
Policy |
A written legal contract of insurance issued by the insurance company to the
policyholder, which outlines the terms of the insurance |
Policy Holder |
Individual that has a written and signed agreement with their insurance provider |
Policy Language |
Clarity of policy explanation |
Policy Lapse |
Length of time the since policy has been active (???) |
Policy Term |
The length of time the insurance policy provides coverage |
Premium |
The annual payment from the individual to the insurance policy to keep the policy
active. |
Premium Rates |
Rates that determine amount of the premium. It is important to research the
history of rate increases for each perspective carrier. |
Premium Stability |
The amount of risk involved in maintaining current premium rate. The lower
the chance of the rate fluctuating, the lower the risk
and the higher the premium stability |
Premium Taxes |
A state controlled tax this is placed on premiums charged by insurance agencies
operating within a state, generally these taxes are
two to three percent of the total premium |
Proof of Loss |
Documents , such as bills that show the break down of money spent on
services provided |
Q |
Quote |
A proposed estimation of the needs of the assessed individual to determine an
appropriate policy |
R |
Rate |
The pricing factor that the insurance company bases their insurance buyer's
premium |
Rated Policy |
Also known as an "Extra-Risk" policy, this policy is issued at a higher than
stated premium rate due to extra risk in the policy
holder, such as impaired health or a dangerous occupation |
Ratemaking |
The process by which insurance companies determine the risks and the pricing
for the classes of insurance |
Reimbursement |
Payment back to the claimant for expenses incurred out of pocket which are
inherently covered by the policy. |
Renewal |
The continuance of the coverage of a policy that is beyond the original length
of time set in the original policy based on the acceptance
of the new policy's premium |
Respite Care |
Care provided through a long-term care facility to temporarily relieve the informal
caregiver's burden of responsibility. |
Rider |
Written contract agreement between insurer and insured which changes the policy
or certificate |
Risk |
The chance of loss |
S |
|
A schedule of benefit coverage that is given to each covered person under the
policy that states the premium amounts, the payment
mode, and a summary of benefits and limitations |
Senescence |
The process of growing old |
Senior Centers |
Provide an assortment of social and recreational services. Many provide
programs offering low cost or free meals. |
Senior Citizen Policies |
Insurance policies for those over the age of 65. In many cases these policies
are in combination with coverage provided by the government
under the Medicare Program |
Senior Transportation Services |
Help seniors with their shopping, medical appointments and other appointments. |
Severe Cognitive Impairment |
A loss or breakdown of the mental capability that is similar to Alzheimer's
Disease and similar forms of dementia. It is measured
by clinical evidence and standard tests that provide
valid information regarding the patient's impairment
which includes (1) memory both short-term and long-term,
(2) orientation to people, places, or time, and (3)
deductive or abstract reasoning. |
Skilled Nursing Care |
This is the highest level of care provided by a Registered Nurse (R.N) or a
Licensed Practical Nurse (L.P.N) 24 hours a day.
It is prescribed by a physician for the most severely
impaired person who cannot perform their own personal
needs. |
Spousal Discount |
Set discount if policy holder is married |
Stability of Carrier |
Strength of the insurance carrier based on their profitability and market share |
Substantial Supervision |
This is continuous supervision that is proved to those who have Severe Cognitive
Impairment, which threatens their health and safety |
T |
Tax Qualified (TQ) Policies |
Beginning January 1, 1997, long-term policies meeting certain requirements qualify
for favorable tax treatment. Buyers of these plans may
deduct the premiums if they itemize their deductions
on their Federal Tax return. Premiums are treated as
medical or health insurance expenses and must be equal
to more then 7.5% of adjusted gross income. Also, benefits
received from a Tax Qualified Plan (TQ Plan) are not
taxable up to $175.00 a day |
"The Lion's Share of the Business" |
In relation to market share, how much of the industry the company generates
and controls, companies that have a large market share
are established and stable, with confidence in their
future. Low market share companies are much less stable
and often provide incentives such as low rates to attract
more customers. |
Transition Expense |
Expense incurred during the time you are waiting for Home Health Care |
Transition Expense Allowance |
Set amount of funds paid during the waiting period, which may be used for in
home equipment |
U |
Underwriting Process |
Steps through which an insurance application is reviewed by a licensed insurance
counselor to become approved for insurance |
Unique Features |
Benefits, options, and advantages that are particular to an insurance carrier |
V |
Validity of Claim |
Judgment passes on claim from house claims department, which verifies that the
claim is accurate and truthful |
W |
Waiting Period |
Period of time lost while waiting for Home Health Care |
Waiver |
An agreement attached to the policy that exempts from coverage specific disabilities
and injuries that normally would be covered under the
policy |
Written Premiums |
The total amount of premiums due in a year for all policies issued by an insurance
company |