LTCI covers care provided outside of hospitals, Health insurance does not cover LTC. Medicaid does, but only for impoverished

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1 LONG TERM CARE INSURANCE

2 Why Long Term Care Insurance? LTCI covers care provided outside of hospitals, for chronic conditions Health insurance does not cover LTC Medicare does not cover LTC Medicaid does, but only for impoverished individuals (more about Partnership policies later)

3 What should you consider? How likely are you to need long term care? Are caregivers available? What is the cost of care in your area? Can you afford premiums for long term care insurance over the long term? Is it a tax qualified or non-tax qualified policy? Does offered policy meet your needs?

4 Outline of Coverage Premium Issues Renewability Waiver of premium Insurer s s right to change premium Free look

5 Outline of Coverage Benefits Covered services including deductibles, waiting periods, elimination periods and benefit maximums Institutional benefits by skill level Non-institutional benefits by skill level Eligibility for Payment of Benefits (benefit triggers) Limitations and exclusions

6 Personal Worksheet Designed to determine financial suitability Discloses insurer s right to raise premiums Insurer s rate increase history Discloses insurer s rate increase history Agent must ask applicant to complete Income/asset questions Inflation protection/elimination period questions Completion is voluntary but important Insurer may not complete sale without the information

7 Rate Increase Disclosure Form Rate schedule Potential rate revisions Options in the event of a rate increase Continue policy Reduce policy benefits Exercise nonforfeiture option Exercise contingent nonforfeiture option

8 Contingent Nonforfeiture Is available if cumulative premium increase exceeds specified amount Varies by age, i.e. % is 90% for issue ages 55-59, 20% for issue age 80 Provides paid up policy benefit CNF Benefit is the total amount paid in premiums before CNF exercised

9 Long Term Care Insurance Partnership (LTC-P) What is Asset Disregard? How does it work? Insured purchases a policy with $100 daily room benefit, 2 year benefit period Insured enters Assisted Living Facility (a covered facility), stays for 2 years Policy pays $ 73,000 in benefits

10 Insured applies for SoonerCare All SoonerCare eligibility criteria apply, except that $73,000 of assets that would ordinarily be counted are disregarded Insured retains $73,000 that would ordinarily have to be spent down For more information:

11 LTC Partnership Requirements Insured must be an Oklahoma resident (or resident of another Partnership state) when coverage first becomes effective Policy must: be tax-qualified and issued no earlier than July 1, 2008 comply with current Oklahoma law and NAIC Model requirements include inflation protection p Insurer must comply with reporting requirements

12 LTC-P Inflation Protection Requirements Insured less than 61 at time of purchase, 3% per year compounded annually, or a rate, compounded annually, that is based upon changes in the Consumer Price Index Insured age 61-75, 3% per year or CPI Insured 76+, inflation protection not required

13 LTC-P Disclosures Prospective applicants must be given a Partnership Program Notice that outlines the requirements and benefits of a Partnership Policy At issue, policy must include a Partnership Disclosure Notice LTC-P disclosures are in addition to other required disclosures

14 LTC-P Exchange Once an insurer begins to offer Partnership Policies, insurer must offer the opportunity to exchange an existing LTC policy for Partnership Policy Insurer must make offer to persons whose LTCs were issued on or after February 8, 2006 Insurer only required to make offer for LTC that is the type certified by the insurer

15 LTC-P Exchange Effective date of Partnership policy is that of the new policy Insured will not lose any rights, benefits or built- up value that has accrued under original policy Exchange may be a new policy or an endorsement to existing policy

16 LTC-P Optional Exchanges For policies issued before February 8, 2006, insurers may offer insureds an option to exchange If insurer does so, all exchange requirements apply, including time limits, underwriting, and rate requirements

17 LTC-P Reporting Requirements LTC Partnership insurers must report to Department of Health and Human Services when Insurance benefits have been paid and the amount of those benefits Partnership policy terminates t

18 Reporting Requirements Upon request of an insured, LTC Partnership insurer must provide insured with LTC Partnership Program Policy Summary. That document includes where the policy was issued, the inflation protection option included in the policy, the amount of benefits paid, and the total dollar amount of insurance benefits remaining.

19 Producer Training Requirements Producers must complete a one-time training course of no less than 8 hours Producers licensed for LTC on July 14, 2008, have one year to complete the one-time training course After the one-time training, producers must complete ongoing training of 4 hours every 24 months

20 Producer Training Requirements LTC insurers shall obtain verification that producer has received training before permitting producer to sell LTC Insurer must maintain verification and make it available to the Department upon request

21 Questions? Please contact ok Or visit our website, Select Consumers, then Senior Issues, then Learn More about SHIP