Long Term Care shopping guide

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A Shopper’s Guide To

Long-Term Care

Insurance

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WYOMING

Wyoming Department of Insurance

106 East 6th Avenue, Cheyenne, WY 82002-0440

(307) 777-7401 • Fax: (307) 777-5895 • http://insurance.state.wy.us

Wyoming Aging Division, Department of Health

6101 Yellow Stone Road, Room 259B, Cheyenne, WY 82002

(307) 777-7986 or 1-800-442-2766 • Fax: (307) 777-5340

Wyoming State Health Insurance Assistance Programs

1-800-856-4398 • (307) 856-6880 • Fax :(307) 856-4466

WISCONSIN

Office of the Commissioner of Ins., State of Wisconsin

PO Box 7873, 125 South Webster Street, GEF III – 2nd floor, Madison, WI 53707-7873

(608) 267-1233 • Fax: (608) 261-8579 • www.oci.wi.gov

Wisconsin Bureau of Aging & LTC Resources, Dept. of Health and Family Services

PO Box 7851, One West Wilson St., Room 450, Madison, WI 53707-7851

(608) 266-2536 • Fax: (608) 267-3203

Wisconsin State Health Insurance Assistance Programs

1-800-242-1060

WEST VIRGINIA

West Virginia Dept. of Insurance

P.O. Box 50540, Charleston, WV 25305-0540

(304) 558-3354 • Fax: (304) 558-0412 • www.wvinsurance.gov

West Virginia Bureau of Senior Services

1900 Kanawha Blvd, East, State Capitol, Charleston, WV 25305-0160

(304) 558-3317 • Fax: (304) 558-5609

West Virginia State Health Insurance Assistance Programs

1-877-987-4463 • (304) 558-3317 • Fax: (304) 558-5609

About the NAIC …

The National Association of Insurance Commissioners (NAIC) is the oldest

association of state government officials. Its members consist of the chief

insurance regulators in all 50 states, the District of Columbia and five U.S.

territories. The primary responsibility of the state regulators is to protect the

interests of insurance consumers, and the NAIC helps regulators fulfill that

obligation in a number of different ways. This guide is one example of work done

by the NAIC to assist states in educating and protecting consumers.

Another way the NAIC lends support to state regulators is by providing a forum

for the development of uniform public policy when uniformity is appropriate. It

does this through a series of model laws, regulations and guidelines, developed

for the states’ use. States that choose to do so may adopt the models intact or

modify them to meet the needs of their marketplace and consumers. As you read

through this guide, you will find several references to such NAIC model laws or

regulations related to long-term care insurance. You may check with your state

insurance department to find out if these NAIC models have been enacted in your

state.

NAIC Executive Office

444 North Capitol Street NW, Suite 701

Washington, DC 20001

Phone: 202-471-3990

NAIC Central Office

2301 McGee Street, Suite 800

Kansas City, MO 64108-2604

Phone: 816-842-3600

Fax: 816-783-8175

NAIC Securities Valuation Office

48 Wall Street, 6th Floor

New York, NY 10005-2906

Phone: 212-398-9000

www.naic.org

Revised 2009

VERMONT

Vermont Division of Insurance, Dept. of Banking, Ins. & Securities

89 Main Street, Drawer 20, Montpelier, VT 05620-3101

(802) 828-3301 • Fax: (802) 828-3306 • www.bishca.state.vt.us

Vermont Department of Aging and Disabilities

103 South Main Street, Waterbury, VT 05671-1601

(802) 241-2196 • Fax: (802) 241-4224

Vermont State Health Insurance Assistance Programs

1-800-639-1873 • (802)-748-5182 • Fax: (802) 748-6622

VIRGIN ISLANDS

Attn.: Marileen Thomas, #18 Kongens Gade, St. Thomas, Virgin Islands 00802

(340) 774-7166 • Fax: (340) 774-9458 or (340) 774-6953

Senior Citizen Affairs, Department of Human Services

#19 Estate Diamond Fredericksted, St. Croix, VI 00840

(340) 692-5950 • Fax: (340) 692-2062

Virgin Islands Health Insurance Assistance Programs

(340) 778-6311 x2338 • Fax: (340) 778-550

VIRGINIA

State Corporation Commission, Bureau of Insurance, Commonwealth of Virginia

P.O. Box 1157, Richmond, VA 23218

(804) 371-9694 • Fax: (804) 371-9873 • www.scc.virginia.gov/division/boi

Virginia Department For The Aging

1610 Forest Avenue, Preston Building, Suite 100, Richmond, VA 23229

(804) 662-9333 • Fax: (804) 662-9354

Virginia State Health Insurance Assistance Programs

1-800-552-3402 • (804) 662-7048 • Fax: (804) 662-9354

WASHINGTON

Washington Office of the Insurance Commissioner

302 Sid Snyder Avenue SW, Insurance Room 200, Olympia, WA 98504-0255

(360) 725-7100 • Fax: (360) 586-3535 • www.insurance.wa.gov

Washington Aging & Disability Services, Dept. of Social & Health Services

PO Box 45050, 14th and Jefferson, Olympia, WA 98504-5050

(360) 902-7797 • Fax: (360) 902-7848

Washington State Health Insurance Assistance Programs

1-800-397-4422 • TDD (360) 664-3154 • (206) 654-1833 • Fax: (206) 389-2745

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A Shopper’s Guide To

Long-Term Care

Insurance

Table of Contents

1 About this Shopper’s Guide

2 What is Long-Term Care?

2 How Much Does Long-Term Care Cost?

3 Nursing Home Costs

3 Assisted Living Facility Costs

3 Home Care Costs

3 Who Pays for Long-Term Care?

3 Individual Personal Resources

3 Medicare

4 Medicare Supplement Insurance

5 Medicaid

5 Long-Term Care Insurance

6 Who May Need Long-Term Care?

7 Do You Need Long-Term Care Insurance?

8 How Can You Buy Long-Term Care Insurance?

8 Individual Policies

9 Policies From Your Employer

9 Federal Government

9 State Government

10 Association Policies

10 Policies Sponsored by Continuing Care Retirement Communities

10 Life Insurance Policies

11 Long-Term Care Insurance Partnership Plans

12 What Types of Policies Can I Buy?

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14 How Do Long-Term Care Insurance Policies Work?

14 How Benefits Are Paid

14 Pooled Benefits and Joint Policies

16 What Services Are Covered

16 Where Services Are Covered

17 What Services Are Not

Covered

(Exclusions and Limitations)

17 How Much Coverage You Will Have

19 When You Are Eligible for Benefits

(Benefit Triggers)

19 Types of Benefit Triggers

20 When Benefits Start

(Elimination Period)

21 What Happens When Long-Term Care Costs Rise (Inflation Protection)?

24 Additional Benefits

24 Other Long-Term Care Insurance Policy Options You Might Choose

25 What Happens If You Cannot Afford the Premiums Anymore?

26 Will Your Health Affect Your Ability to Buy a Policy?

27 What Happens If You Have Pre-Existing Conditions?

27 Can You Renew Your Long-Term Care Insurance Policy?

28 How Much Do Long-Term Care Insurance Policies Cost?

30 What Options Do I Have to Pay the Premiums on the Policy?

31 If You Already Own a Policy, Should You Switch Plans or Upgrade

the Coverage You Have Now?

32 What Shopping Tips Should You Keep in Mind?

36 References

37 Glossary

45 Worksheets

45 Worksheet 1: Information About the Availability and Cost of

Long- Term Care in Your Area

47 Worksheet 2: How to Compare Long-Term Care Insurance Policies

52 Worksheet 3: Facts About Your Long-Term Care Insurance Policy

54 Worksheet 4: Long-Term Care Riders to Life Insurance Policies

56 Personal Worksheet

60 List of State Insurance Departments, Agencies on Aging and State

Health Insurance Assistance Programs

 About this Shopper’s Guide

The National Association of Insurance Commissioners (NAIC) has written

this guide to help you understand long-term care and the insurance options

that can help you pay for long-term care services. The decision to buy long-

term care insurance is very important and one you shouldn’t make in a hurry.

In most states, state law requires insurance companies or agents to give you

this guide to help you better understand long-term care insurance and decide

which, if any, policy to buy. Some states produce their own guide.

Take a moment to look at the table of contents and you’ll see the questions

this guide answers and the information that is in it. Then, read the guide

carefully. If you see a term you don’t understand, look in the glossary starting

on page 37. (Terms in blue in the text are in the glossary.) Take your time.

Decide if buying a policy might be right for you.

If you decide to shop for a long-term care insurance policy, start by getting

information about the long-term care services and facilities you might use and

how much they charge. Use the first worksheet that starts on page 45 to write

down this information. Then, as you shop for a policy, use Worksheet 2,

starting on page 47. There you can write down the information you collect to

compare policies and buy the one that best meets your needs.

If you have questions, call your state insurance department or the

insurance counseling program in your state. The telephone numbers are

listed starting on page 60 of this guide.

 What is Long-Term Care Insurance?

Someone with a prolonged physical illness, a disability or a cognitive

impairment (such as Alzheimer’s disease) often needs long-term care.

Many different services help people with chronic conditions overcome

limitations that keep them from being independent. Long-term care is

different from traditional medical care. Long-term care helps one live as he

or she is now; it may not help to improve or correct medical problems.

Long-term care services may include help with activities of daily living,

home health care, respite care, hospice care, adult day care, care in

a nursing home, or care in an assisted living facility. Long-term care

may also include care management services, which will evaluate your needs

and coordinate and monitor the delivery of long-term care services.

Someone with a physical illness or disability often needs hands-on or

stand-by assistance with activities of daily living (see page 19). People

with cognitive impairments usually need supervision, protection or verbal

reminders to do everyday activities. The way long-term care services are

provided is changing. Skilled care and personal care are still the terms used

most often to describe long-term care and the type or level of care you

may need.

People usually need skilled care for medical conditions that require care by

medical personnel such as registered nurses or professional therapists. This

care is usually needed 24 hours a day, a physician must order it, and it

must follow a plan. Individuals usually get skilled care in a nursing home

but may also receive it in other places. For example, you might get skilled

care in your home with help from visiting nurses or therapists. Skilled care

includes physical therapy, caring for a wound, or supervising the

administration of intravenous medication.

NOTE: Medicare and Medicaid have their own definitions of skilled care. Please

refer to The Guide to Health Insurance for People with Medicare or The Medicare

Handbook to find out how Medicare defines skilled care. Contact your local social

services office for questions about Medicaid’s definition of skilled care. For copies of

these publications, contact your state insurance department or State Health

Insurance Assistance Program listed on pages 60-73.

Personal care (sometimes called custodial care) helps one with activities

of daily living (ADLs.) These activities include bathing, eating, dressing,

toileting, continence and transferring. Personal care is less involved

than skilled care, and it may be given in many settings.

 How Much Does Long-Term Care Cost?

Long-term care can be expensive. The cost depends on the amount and

type of care you need and where you get it. Below are some average

annual costs for care provided in a nursing home, in an assisted living

facility and in your own home.

Nursing Home Costs

In 2007, the national average cost of nursing home care was about $181

per day (for a semi-private room).

This cost does not include items such

as therapies and medications, which could make the cost much higher.

Assisted Living Facility Costs

In 2007, assisted living facilities reported charging an average fee of

$2,714 per month (for a one-bedroom unit), or $32,568 per year, including

rent and most other fees.

Some residents in the facilities may pay a lot

more if their care needs are higher.

Home Care Costs

In 2007, the national average cost of part-time basic home care (home

health aide three times a week) averaged $16,000 per year.

Skilled care

provided by a nurse is more expensive than care provided by a home

health aide. Annual costs for home health care will vary based on the

number of days per week the caregiver visits, the type of care required and

the length of each visit. Home health care can be expensive if round-the-

clock care is required. These costs are different across the country. Your

state insurance department or the insurance counseling program in your

state may have costs for your area. (See directory starting on page 60.)

 Who Pays For Long-Term Care?

People pay for long-term care in a variety of ways. These include: using the

personal resources of individuals or their families, long-term care insurance,

and some assistance from Medicaid for those who qualify. Medicare,

Medicare supplement insurance, and the health insurance you may have

at work usually will not pay for long-term care.

Individual Personal Resources

Individuals and their families generally pay for part or all of the costs of

long-term care from their own funds. Many use savings and investments.

Some people sell assets, such as their homes, to pay for their long-term

care needs.

Medicare

Medicare’s skilled nursing facility (SNF) benefit does not cover most nursing

home care.

Medicare will pay the cost of some skilled care in an approved

nursing home or in your home, but only in specific situations. The SNF

benefit only covers you if a medical professional says you need daily skilled

care after you have been in the hospital for at least three days and you are

receiving that care in a nursing home that is a Medicare-certified skilled

nursing facility. While Medicare may cover up to 100 days of skilled nursing

home care per benefit period when these conditions are met, after 20 days

beneficiaries must pay a coinsurance fee. In 2008, that coinsurance was

$128 per day.

While Medicare may pay for nursing home care sometimes,

it doesn’t cover the costs of care in assisted living facilities.

While many people would like to receive care in their own homes, Medicare

does not cover homemaker services. In addition, Medicare doesn’t pay

for home health aides to give you personal care unless you are

homebound and are also getting skilled care, such as nursing or therapy.

The personal care must also relate to the treatment of an illness or injury,

and you can only get a limited amount of care in any week.

You should not rely on Medicare to pay for your long-term care

needs.

Medicare Supplement Insurance

Medicare supplement insurance is private insurance that helps pay for some

of the gaps in Medicare coverage, such as hospital deductibles and excess

physician charges above what Medicare approves. Medicare supplement

policies do not cover long-term care costs. However, four Medicare

supplement policies—Plans D, G, I and J—do pay up to $1,600 per year

for

services to people recovering at home from an illness, injury or surgery.

The benefit will pay for short-term, at-home help with activities of daily

living. You must qualify for Medicare-covered home health services before

this Medicare supplement benefit is available.

Medicaid

Medicaid is the government-funded program that pays nursing home care

only for individuals who are low income and who have spent most of their

assets. Medicaid pays for nearly half of all nursing home care on an

aggregate basis, but many people who need long-term care never qualify

for Medicaid assistance.

Medicaid also pays for some home- and

community-based services. To get Medicaid help, you must meet federal

and state guidelines for income and assets. Many people start paying for

nursing home care out of their own funds and “spend down” their income

until they are eligible for Medicaid. Medicaid may then pay part or all of

their nursing home costs. You may have to use up most of your assets on

your health care before Medicaid is able to help. Some assets and income

can be protected for a spouse who remains at home. In addition, some of

your assets may be protected if you have long-term care insurance

approved under one of the state long-term care insurance partnership

programs. (See section on partnership programs on page 11.)

State laws differ about how much money and assets you can keep and be

eligible for Medicaid. (Some assets, such as your home, may not count

when deciding if you are eligible for Medicaid.) However, federal law

requires your state to recover from your estate the costs of the Medicaid-

paid benefits you receive.

Contact your state Medicaid office, office on

aging or department of social services to learn about the rules in

your state. The insurance counseling program in your state also

may have some Medicaid information. (Please see the list of offices on

aging and counseling programs starting on page 60.)

Long-Term Care Insurance

Long-term care insurance is one other way you may pay for long-term care.

This type of insurance will pay or reimburse you for some or all of your

long-term care. It was introduced in the 1980s as nursing home insurance

but has changed a lot and now covers much more than nursing home care.

The rest of this Shopper’s Guide will give you information on long-term care

insurance.

You should know that a federal law, the Health Insurance Portability

and Accountability Act of 1996, or HIPAA, gives some federal income tax

advantages to people who buy certain long-term care insurance policies.

These policies are called Tax-Qualified Long-Term Care Insurance Contracts,

or simply Qualified Contracts. The tax advantages of these policies are

outlined on page 15. There may be other tax advantages in your state. You

should check with your state insurance department or insurance

counseling program for information about tax-qualified policies.

(See the list of state insurance departments and counseling

programs starting on page 60.) Check with your tax advisor to find

out if the tax advantages make sense for you.

 Who May Need Long-Term Care?

The need for long-term care may begin

gradually as you find that you need

more and more help with activities of

daily living, such as bathing and

dressing or independent activities of

daily living (IADLs) such as household

chores, meal preparation, or managing

money. Or you may suddenly need

long-term care after a major illness,

such as a stroke or a heart attack. If

you do need care, you may need

nursing home or home health care for

only a short time. Or, you may need

these services for many months, years

or the rest of your life.

It is hard to know if and when you will

need long-term care, but there are

some statistics that may help. For

example:

• Life expectancy after age 65 has now

increased to 17.9 years. In 1940,

life expectancy after 65 was only 13

extra years. The longer people live,

the greater the chances they will

need assistance due to chronic

conditions.

• About 12.8 million Americans of all

ages require long-term care, but only

2.4 million live in nursing homes.

• About 44% of people reaching age

65 are expected to enter a nursing

home at least once in their lifetime.

Of those who do enter a nursing

home, about 53%will stay for one year or more.

• Most persons needing long-term care are elderly. Approximately 63%

are persons aged 65 and older (6.3 million). The remaining 37% are 64

years of age or younger (3.7 million).

• The lifetime probability of becoming disabled in at least two activities of

daily living or being cognitively impaired is 68% for people age 65 and

older.

• By 2050, the number of individuals using paid long-term care services or

skilled nursing facilities will likely double from 13 million to 27 million.

This estimate is influenced by growth in the population of older people in

need of care.

 Do You Need Long-Term Care Insurance?

Whether you should buy a long-term care insurance policy will depend on

your age, health status, overall retirement goals, income and assets. For

instance, if your only source of income is a Social Security benefit or

Supplemental Security Income (SSI), you probably shouldn’t buy long-term

care insurance, as you may not be able to afford the premium.

On the other hand, if you have a large amount of assets but don’t want to

use them to pay for long-term care, you may want to buy a long-term care

insurance policy. Many people buy a policy because they want to stay

independent of government aid or the help of family. They don’t want to

burden anyone with having to care for them. However, you should not buy

a policy if you cannot afford the premium or aren’t sure you can pay the

premium for the rest of your life.

If you already have health problems that are likely to mean you will need

long-term care (for example, Alzheimer’s or Parkinson’s disease), you

probably won’t be able to buy a policy. Insurance companies have medical

underwriting standards to keep the cost of long-term care insurance

affordable. Without such standards, most people would not buy coverage

until they needed long-term care services.

Some states have a regulation requiring the insurance company and the

agent to go through a worksheet with you to decide if long-term care

insurance is right for you. The worksheet describes the premium for the

policy you’re thinking about buying and asks you questions about the

source and amount of your income and the amount of your savings and

investments. Some states require you to fill out the worksheet and send it

to the insurance company. Even if you aren’t required to fill out the

worksheet, it might help you decide if long-term care insurance is right for

you.

Remember, not everyone should buy a long-term care insurance policy. For

some, a policy is affordable and worth the cost. For others, the cost is too

great, or the policy they can afford doesn’t offer enough benefits to make it

worthwhile. You should not buy long-term care insurance if the only way

you can afford to pay for it is by not paying other important bills. Look

closely at your needs and resources, and discuss it with a family member to

decide if long-term care insurance is right for you. (There are several

worksheets at the back of this book that will help you as you think about

whether you should buy long-term care insurance.)

For further determination of whether you should or should not consider

buying long-term care insurance, please refer to the Personal Worksheet

found in the back of this Shopper’s Guide. In addition to the personal

worksheet, consumer worksheets #1 through #4 should be used to help

you decide.

A Shopper’s Guide to Long-Term Care Insurance

Is Long-Term Care

Insurance Right For You?

You should NOT buy Long-Term Care Insurance if:

• You cannot afford the premiums.

• You have limited assets.

• Your only source of income is a Social Security benefit or

Supplemental Security Income (SSI).

• You often have trouble paying for utilities, food, medicine, or

other important needs.

• You are on Medicaid.

You should CONSIDER buying Long-Term Care Insurance if:

• You have significant assets and income.

• You want to protect some of your assets and income.

• You can pay premiums, including possible premium increases,

without financial difficulty.

• You want to stay independent of the support of others.

• You want to have the flexibility of choosing care in the setting

you prefer or will be most comfortable in.

If, after careful consideration, you decide that long-term care insurance is

right for you, check out the company and the agent, if one is involved,

before you buy a policy. Insurance companies and agents must be licensed

in your state to sell long-term care insurance. If you’re not sure, contact

your state insurance department. (Please see the list of state insurance

departments starting on page 60.)

 How Can You Buy Long-Term Care Insurance?

Private insurance companies sell long-term care insurance policies. You can

buy an individual policy from an agent or through the mail. Or, you can buy

coverage under a group policy through an employer or through membership

in an association. The federal government and several state governments

offer long-term care insurance coverage to their employees, retirees and

their families. This program is voluntary, and premiums are paid by

participants. You can also get long-term care benefits through a life

insurance policy.

Individual Policies

Today, most long-term care insurance policies are sold to individuals.

Insurance agents sell many of these policies, but companies also sell

policies through the mail or by telephone. You will find that individual

policies can be very different from one company to the next. Each company

may also offer policies with different combinations of benefits. Be sure to

shop among policies, companies and agents to get the coverage that best

fits your needs.

Policies From Your Employer

Your employer may offer a group long-term care insurance plan or offer

individual policies at a group discount. An increasing number of employers

offer this benefit,

especially since the passage of the Health Insurance

Portability and Accountability Act (HIPAA). HIPAA allows employers the

same type of federal tax benefit when they pay for their employees’ long-

term care insurance as when they pay for their health insurance (except for

Section 125 cafeteria plans).

The employer-group plan may be similar to what you could buy in an

individual policy. If you are an active employee, one advantage of an

employer-group plan is you may not have to meet any medical

requirements to get a policy or there may be a relaxed screening process

for active employees. Many employers also let retirees, spouses, parents

and parents-in-law apply for this coverage. Relatives must usually pass the

company’s medical screening to qualify for coverage and must pay the

premium.

Generally, insurance companies must let you keep your coverage after your

employment ends or your employer cancels the group plan. In most cases,

you will be able to continue your coverage or convert it to another long-

term care insurance policy. Your premiums and benefits may change,

however.

If an employer offers long-term care insurance, be sure to think about it

carefully. An employer-group policy may offer you options you cannot find if

you buy a policy on your own.

Federal Government

Federal and U.S. Postal Service employees and annuitants, members and

retired members of the uniformed services, and qualified relatives of any of

these are eligible to apply for long-term care insurance coverage under the

Federal Long Term Care Insurance Program. Private insurance companies

underwrite the insurance, and the federal government does not pay any of

the premiums. The group rates under this program may or may not be

lower than individual rates, and the benefits may also be different.

State Government

If you or a member of your family is a state or public employee or retiree,

you may be able to buy long-term care insurance under a state government

program.

Association Policies

Many associations let insurance companies and agents offer long-term care

insurance to their members. These policies are like other types of long-term

care insurance and typically require medical underwriting. Like employer-

group policies, association policies usually give their members a choice of

benefit options. In most cases, policies sold through associations must let

members keep or convert their coverage after leaving the association. Be

careful about joining an association just to buy any insurance coverage.

Review your rights if the policy is terminated or canceled.

Policies Sponsored by Continuing Care Retirement

Communities

Many Continuing Care Retirement Communities (CCRC) offer or require

you to buy long-term care insurance. A CCRC is a retirement complex that

offers a broad range of services and levels of care. You must be a resident

or on the waiting list of a CCRC and meet the insurance company’s medical

requirements to buy its long-term care insurance policy. The coverage will

be similar to other group or individual policies.

Life Insurance Policies

Some companies let you use your life insurance death benefit to pay for

specific conditions such as terminal illness or for qualified long-term care

expenses such as home health care, assisted living or nursing home care. A

life insurance death benefit you use while you are alive is known as an

accelerated death benefit. A life insurance policy that uses an accelerated

death benefit to pay for long-term care expenses may also be known as a

“life/long-term care” policy. It may be an individual or a group life

insurance policy. The company pays you the actual charges for care when

you receive long-term care services, but no more than a certain percent of

the policy’s death benefit per day or per month. Policies may pay part or all

of the death benefit for qualified long-term care expenses. Some companies

let you buy more long-term care coverage than the amount of your death

benefit in the form of a rider.

Some policies may allow you to withdraw the cash value of your policy to

pay for specific conditions and expenses. It is important to remember that

if you use money from your life insurance policy to pay for long-term care,

it will reduce the death benefit the beneficiary will get. For example, if you

buy a policy with a $100,000 death benefit, using $60,000 for long-term

care will cut the death benefit of your policy to $40,000. It may also affect

the cash value of your policy. Ask your agent how this may affect other

aspects of your life insurance policy. If you bought life insurance to meet a

specific need after your death, your survivors may not be able to meet that

need if you use your policy to pay for long-term care. If you never use the

long-term care benefit, the policy will pay the full death benefit to your

beneficiary.

Long-Term Care Insurance Partnership Plans

Some states have long-term care insurance

partnership programs designed to help

people with the financial impact of spending

down to meet Medicaid eligibility standards.

Under these partnership programs, when you

buy a specially approved insurance policy,

you will receive protection against the normal

Medicaid requirement to spend down your

assets to become eligible.

The long-term care partnership program is a

creation of federal law allowing states to alter

their Medicaid program to allow assets to be

disregarded based upon claims paid by

qualified long-term care insurance policies.

Most states allow a dollar-for-dollar asset disregard for claims paid on

qualified partnership policies and will not require you to exhaust the

benefits offered under the partnership policy in order to qualify for

Medicaid. Under the partnership program, if you need additional coverage

beyond what is provided by your qualified partnership policy, you can

access Medicaid without depleting all your assets.

Benefits of the Partnership Program

• Partnership policies are tax-qualified plans under federal law, must

contain certain consumer protections and must provide inflation

protection benefits for purchasers so that benefits keep up with the cost

of inflation over time.

• The long-term care partnership program provides an alternative to

spending down or transferring assets by forming a partnership between

Medicaid and private long-term care insurers.

• Once private insurance benefits are used, special Medicaid eligibility

rules are applied if additional coverage is necessary.

Key Features of Long-Term Care Partnership Policies

• The policies must be tax-qualified plans.

• Policies must provide inflation protection:

- Those under age 61 at date of purchase must have compound annual

inflation protection.

- Those at least 61 years of age but under the age of 76 must have

some level of inflation protection.

- Those over the age of 76 may have but are not required to have

inflation protection.

How Will I Know I Have Purchased a Partnership Policy?

• If the policy you purchased is a partnership plan, you will receive written

notice from the insurance company. Depending upon the state, it will be

in one of the following ways:

- Your policy or certificate will be identified as a partnership policy in

the policy itself either on the front page or on the schedule page of

the policy.

- You will receive a letter from your insurance company advising you

that you have purchased a partnership policy. If this is the only

notification you receive, it is extremely important to keep this letter.

Please keep in mind that these programs have specific requirements in each

state in which they are offered. Check with your state insurance

department or counseling program to see if these policies are

available in your state. Many states with long-term care partnership

programs have information about them on their Web sites. To locate your

state’s insurance department Web site, visit

www.naic.org/state_web_map.htm. Also, the U.S. Department of Health

and Human Services maintains a Web site with information on long-term

care insurance and the partnership program at www.longtermcare.gov.

 What Types of Policies Can I Buy?

You may be asked to choose between a “tax-qualified” long-term care

insurance policy and one that is “non-tax-qualified.” There are important

differences between the two types of policies. These differences were

created by the Health Insurance Portability and Accountability Act (HIPAA).

A federally tax-qualified long-term care insurance policy, or a qualified

policy, offers certain federal income tax advantages. If you have a qualified

long-term care policy and you itemize your deductions, you may be able to

deduct part or all of the premium you pay for the policy. You may be able

to add the premium to your other deductible medical expenses. You may

then be able to deduct the amount that is more than 7.5% of your adjusted

gross income on your federal income tax return. The amount depends on

your age, as shown in the following table.

Your Age

Maximum Amount

You Can Claim

40 years or younger $320

More than 40 but not more than 50 $600

More than 50 but not more than 60 $1,190

More than 60 but not more than 70 $3,180

70 years or older $3,980

2009 figures.

These amounts will increase annually based on the Medical Consumer Price Index.

13 58

Regardless of which policy you choose, make sure that you understand how

the benefits and triggers will work and that they are acceptable to you.

For example, benefits paid by a qualified long-term care insurance policy

are generally not taxable as income. Benefits from a long-term care

insurance policy that is not qualified may be taxable as income.

If you bought a long-term care insurance policy before January 1, 1997,

that policy is probably qualified. HIPAA allowed these policies to be

“grandfathered,” or considered qualified, even though they may not meet

all of the standards that new policies must meet to be qualified. The tax

advantages are the same whether the policy was sold before or after 1997.

You should carefully examine the advantages and disadvantages of trading

a grandfathered policy for a new policy. In most cases, it will be to your

advantage to keep your old policy.

Long-term care insurance policies that are sold on or after January 1, 1997,

as tax-qualified must meet certain federal standards. To be qualified,

policies must be labeled as tax-qualified, be guaranteed renewable,

include a number of consumer protection provisions, cover only qualified

long-term care services, and generally can provide only limited cash

surrender values. (See Benefit Triggers, page 19.)

Qualified long-term care services are those generally given by long-term

care providers. These services must be required by chronically ill individuals

and must be given according to a plan of care prescribed by a licensed

health care practitioner. You are considered chronically ill if you are

expected to be unable to do at least two activities of daily living without

substantial assistance from another person for at least 90 days. Another

way you may be considered to be chronically ill is if you need substantial

supervision to protect your health and safety because you have a

cognitive impairment. A policy issued to you before January 1, 1997,

doesn’t have to define chronically ill this way. (See Benefit Triggers, page

19.)

Some life insurance policies with long-term care benefits may be tax-

qualified. You may be able to deduct the premium you pay for the long-

term care benefits that a life insurance policy provides. However, be sure to

check with your personal tax advisor to learn how much of the premium

can be deducted as a medical expense.

The long-term care benefits paid from a tax-qualified life insurance policy

with long-term care benefits are generally not taxable as income. Tax-

qualified life insurance policies with long-term care benefits must meet the

same federal standards as other tax-qualified policies, including the

requirement that you must be chronically ill to receive benefits.

 How Do Long-Term Care Insurance Policies

Work?

Long-term care insurance policies are not standardized like Medicare

supplement insurance. Companies sell policies that combine benefits and

coverage in different ways.

How Benefits Are Paid

Insurance companies that sell long-term care insurance generally pay

benefits using one of three different methods: the expense-incurred

method, the indemnity method, or the disability method. It is important to

read the literature that accompanies your policy (or certificate for group

policies) and to compare the benefits and premiums.

When the expense-incurred method is used, the insurance company must

decide if you are eligible for benefits and if your claim is for eligible

services. Your policy or certificate will pay benefits only when you receive

eligible services. Once you have incurred an expense for an eligible service,

benefits are paid either to you or your provider. The coverage will pay for

the lesser of the expense you incurred or the dollar limit of your policy.

Most policies bought today pay benefits using the expense-incurred

method.

When the indemnity method is used, the benefit is a set dollar amount. The

benefit is not based on the specific services received or on the expenses

incurred. The insurance company only needs to decide if you are eligible for

benefits and if the services you are receiving are covered by the policy.

Once the company decides you are eligible and you are receiving eligible

long-term care services, the insurance company will pay that set amount

directly to you up to the limit of the policy.

When the disability method is used, you are only required to meet the

benefit eligibility criteria. Once you do, you receive your full daily benefit,

even if you are not receiving any long-term care services.

Pooled Benefits and Joint Policies

You may be able to buy a long-term care insurance policy that covers more

than just one person, or more than one kind of long-term care service. The

benefits provided by these policies are often called “pooled benefits.”

One type of pooled benefit covers more than one person, such as a

husband and wife, or two partners, or two or more related adults. This type

of benefit is sometimes called a “joint policy” or a “joint benefit.” This

pooled benefit usually has a total benefit that applies to all of the

individuals covered by the policy. If one of the covered individuals collects

benefits, that amount is subtracted from the total policy benefit. For

Federally Tax-Qualified

Policies

1. Premiums can be included with

other annual uncompensated

medical expenses for deductions

from your income in excess of

7.5% of adjusted gross income up

to a maximum amount adjusted

for inflation.

2. Benefits that you receive and use

to pay for long-term care services

generally will not be counted as

income. For policies that pay

benefits using the expense

incurred method, benefits that you

receive in excess of the costs of

long term care services may be

taxable. For policies that pay

benefits using the indemnity or

disability methods, all benefit

payments up to the federally

approved per diem (daily) rate are

tax-free even if they exceed your

expenses.

3. To trigger the benefits under your

policy, the federal law requires you

to be unable to do two ADLs

without substantial assistance.

4. “Medical necessity” cannot be used

as a trigger for benefits

5. Chronic illness or disability must

be expected to last for at least 90

days.

6. For cognitive impairment to be

covered, a person must require

“substantial supervision.”

Federally Non-Tax

Qualified Policies

1. You may or may not be able to

deduct any part of your annual

premiums. Congress and the U.S.

Department of the Treasury have

not clarified this area of the law.

2. Benefits that you receive may or

may not count as income.

Congress and the U.S. Department

of the Treasury have not clarified

this area of the law.

3. Policies can offer a different

combination of benefit triggers.

Benefit triggers are not restricted

to two ADLs.

4. “Medical necessity” and/or other

measures of disability can be

offered as benefit triggers.

5. Policies don’t have to require that

the

disability be expected to last for at

least 90 days.

6. Policies don’t have to require

“substantial supervision” to trigger

benefits for cognitive impairments.

Whether you are considering buying a tax-qualified or a non-tax-qualified policy, consult with your tax

consultant or legal advisor regarding the tax consequences in your situation.

example, if a husband and wife have a policy that provides $150,000 in

total long-term care benefits, and the husband uses $25,000 in benefits

from the policy, $125,000 would be left to pay benefits for either the

husband or the wife, or both.

Another kind of “pooled benefit” provides a total dollar amount that can be

used for various long-term care services. These policies pay a daily, weekly,

or monthly dollar limit for one or more covered services. You can combine

benefits in ways that best meet your needs. This gives you more control

over how your benefits are spent. For example, you may choose to combine

the benefit for home care with the benefit for community-based care

instead of using the nursing home benefit.

Some policies provide both types of pooled benefits. Other policies provide

one or the other.

What Services Are Covered

It is important that you understand what services your long-term care

insurance policy covers and how it covers the many types of long-term care

services you might need to use. Policies may cover the following:

• Nursing home care

• Home health care

• Respite care

• Hospice care

• Personal care in your home

• Services in assisted living facilities

• Services in adult day care centers

• Services in other community facilities

There are several ways policies may cover home health care. Some long-

term care insurance policies only pay for care in your home from licensed

home health agencies. Some also will pay for care from licensed health care

providers not from a licensed agency. These include licensed practical

nurses; occupational, speech, or physical therapists; or licensed home

health care aides. Other policies may pay for services from home health

care aides who may not be licensed or are not from licensed agencies.

Home health care aides help with personal care. You may find a policy that

pays for homemaker or chore worker services. This type of benefit, though

not available in all policies, would pay for someone to come to your home

to cook meals and run errands. Generally, adding home care benefits to a

policy also adds to the cost of the policy.

NOTE: Some policies pay benefits to family members who give care in the home.

Where Services Are Covered

You should know what types of facilities are covered by your long-term care

insurance policy. If you’re not in the right type of facility, the insurance

company can refuse to pay for eligible services. New kinds of facilities may

be developed in the future, and it is important to know whether your policy

will cover them.

Some policies may pay for care in any state-licensed facility. Others only

pay for care in some state-licensed facilities, such as a licensed nursing

facility. Still others list the types of facilities where services will not be

covered, which may include state-licensed facilities. (For example, some

places that care for elderly people are referred to as homes for the aged,

rest homes or personal care homes, and are often not covered by long-

term care policies). Some policies may list specific points about the kinds of

facilities they will cover. Some will say the facilities must care for a certain

number of patients or give a certain kind of care. When shopping for a

long-term care policy, check these points carefully and compare the types

of services and facilities covered in the policy. Also, be aware that many

states, companies and policies define assisted living facilities differently.

Policies that cover assisted living facilities in one state may not cover

services provided in an assisted living facility in another state. Before you

move or retire to another state, ask if your policy covers the types of

services and facilities available in your new state. Also, if your policy lists

kinds of facilities, be sure to check if your policy requires the facility to

have a license or certification from a government agency.

NOTE: If you do NOT reside in the kind of facility specified by your policy, the

insurance company may not pay for the services you require.

What Services Are Not Covered (Exclusions and Limitations)

Most long-term care insurance policies usually do not pay benefits for:

• A mental or nervous disorder or disease, other than Alzheimer’s

disease or other dementia.

• Alcohol or drug addiction.

• Illness or injury caused by an act of war.

• Treatment the government has provided in a government facility or

already paid for.

• Attempted suicide or intentionally self-inflicted injuries.

NOTE: In most states, regulations require insurance companies to pay for covered

services for Alzheimer’s disease that may develop after a policy is issued. Ask your

state insurance department if this applies in your state. Nearly all policies

specifically say they will cover Alzheimer’s disease. Read about Alzheimer’s disease

and eligibility for benefits in the section on benefit triggers on page 19.

NOTE: Many policies exclude or limit coverage for care outside of the United

States.

How Much Coverage You Will Have

The policy or certificate may state the amount of coverage in one of several

ways. A policy may pay different amounts for different types of long-term

care services. Be sure you understand how much coverage you will have

and how it will cover long-term care services you receive.

Maximum Benefit Limit. Most policies limit the total benefit they will pay

over the life of the policy, but a few don’t. Some policies state the

maximum benefit limit in years (one, two, three or more, or even lifetime).

Others write the policy maximum benefit limit as a total dollar amount.

Policies often use words like “total lifetime benefit,” “maximum lifetime

benefit,” or “total plan benefit” to describe their maximum benefit limit.

When you look at a policy or certificate, be sure to check the total amount

of coverage. In most states, the minimum benefit period is one year. Most

nursing home stays are short, but illnesses that go on for several years

could mean long nursing home stays. You will have to decide if you want

protection for very long stays. Policies with longer maximum benefit periods

cost more. Read your long-term care insurance policy carefully to learn

what the benefit period is.

Daily/Weekly/Monthly Benefit Limit. Policies normally pay benefits by

the day, week or month. For example, in an expense-incurred plan, a policy

might pay a daily nursing home benefit of up to $200 per day or $6,000

per month, and a weekly home care benefit of up to $1,400 per week.

Some policies will pay one time for single events, such as installing a home

medical alert system.

When you buy a policy, insurance companies let you choose a benefit

amount (usually $50 to $350 a day, $350 to $2,450 a week, or $1,500 to

$10,500 a month) for care in a nursing home. If a policy covers home care,

the benefit is usually a portion of the benefit for nursing home care (e.g.,

50% or 75%), although a growing number of policies pay the same benefit

amounts for care at home as in a facility. Often, you can select the home

care benefit amount that you prefer. It is important to know how much

skilled nursing homes, assisted living facilities, and home health care

agencies charge for their services BEFORE you choose the benefit amounts

in your long-term care insurance policy. Check the facilities in the area

where you think you may be receiving care, whether they are local, near a

grown child, or in a new place where you may retire. The worksheet on

page 45 can help you track these costs.

When You Are Eligible for Benefits (Benefit Triggers)

The term usually used to describe the way insurance companies decide

when to pay benefits is “benefit triggers.” This term refers to the criteria

and the methods that the insurance company uses to evaluate when you

are eligible for benefits, and the conditions you must meet to receive

benefits. This is an important part of a long-term care insurance policy.

Look at it carefully as you shop. The policy and the outline of coverage

usually describe the benefit triggers. Look for a section called “Eligibility for

the Payment of Benefits” or simply “Eligibility for Benefits.” Different policies

may have different benefit triggers. Some states require certain benefit

triggers, and the benefit triggers for tax-qualified contracts are also fairly

standardized across insurance policies. Check with your state insurance

department to find out what your state requires.

NOTE: Companies may use different benefit triggers for home health

care coverage than for nursing home care, although most do not do

so. If they do, they generally have a more restrictive benefit trigger

for nursing home care than for home care.

Types of Benefit Triggers

Activities of Daily Living. The inability to do activities of daily living, or

ADLs, is the most common way insurance companies decide when you are

eligible for benefits. The ADLs most companies use are bathing, continence,

dressing, eating, toileting and transferring. Typically, a policy pays benefits

when you cannot do a certain number of the ADLs, such as two of the six

or three of the six. The more ADLs you must be unable to do, the harder it

will be for you to become eligible for benefits. Federally tax-qualified

policies are required to use the inability to do certain ADLs as a benefit

trigger. A qualified policy requires that a person be unable to perform at

least two of their ADLs to collect benefits. The ADLs that trigger benefits in

a tax-qualified policy must come from the list above. These triggers are

specified in your policy.

If the policy you’re thinking of buying pays benefits when you cannot do

certain ADLs, be sure you understand what that means. Some policies spell

out very clearly what it means to be unable to feed or bathe oneself. Some

policies say that you must have someone actually help you do the

activities. That’s known as hands-on assistance. Specifying hands-on

assistance will make it harder to qualify for benefits than if only stand-by

assistance is required. The more clearly a policy describes its requirements,

the less confusion you or your family will have when you need to file a

claim.

NOTE: The six activities of daily living (ADLs) have been developed through years

of research. This research also has shown that bathing is usually the first ADL that

a person cannot do. While most policies use all six ADLs as benefit triggers,

qualifying for benefits from a policy that uses five ADLs may be more difficult if

bathing isn’t one of the five.

Cognitive Impairment. Most long-term care insurance policies also pay

benefits for “cognitive impairment.” The policy usually pays benefits if you

cannot pass certain tests of cognitive function.

Coverage of cognitive impairment is especially important if you develop

Alzheimer’s disease or other dementia. If being unable to do ADLs is the

only benefit trigger your policy uses, it may not pay benefits if you have

Alzheimer’s disease but can still do most of the ADLs on your own. But if

your policy also uses a test of your cognitive ability as a benefit trigger, it is

more likely to pay benefits if you have Alzheimer’s disease. Most states do

not allow policies to limit benefits solely because you have Alzheimer’s

disease.

Doctor Certification of Medical Necessity. Some long-term care

insurance policies will pay benefits if your doctor orders or certifies that the

care is medically necessary. However, tax-qualified policies cannot use this

benefit trigger.

Prior Hospitalization. Long-term care insurance policies sold in the past

required a hospital stay of at least three days before paying benefits. Most

companies no longer sell policies that require a hospital stay.

NOTE: Medicare still requires a three-day hospital stay to be eligible for Medicare

payment of skilled nursing facility benefits.

When Benefits Start (Elimination Period)

With many policies, your benefits won’t start the first day you go to a

nursing home or start using home care. Most policies have an elimination

period (sometimes called a deductible or a waiting period). That means

benefits can start zero, 20, 30, 60, 90, or 100 days after you start using

long-term care or become disabled. Elimination periods for nursing home

and home health care may be different, or there may be a single

elimination period that applies to any covered service. How many days you

have to wait for benefits to start will depend on the elimination period you

pick when you buy your policy. You might be able to choose a policy with a

zero-day elimination period, but expect it to cost more.

Some policies calculate the elimination period using calendar days, while

other policies count only the days on which you receive a covered service.

Under the calendar days method, every day of the week would count in

determining the elimination period regardless of whether you received any

services on those days. Under the days of service method, only days when

you receive services will count toward the elimination period. This means if

you only receive services three days a week, it will take longer for your

benefits to start, and it could mean that you have more out-of-pocket

expenses before your benefits begin. Also, some policies have an

elimination period that you only need to satisfy once in your lifetime, while

other policies require that you satisfy the elimination period with each

“episode of care.” Some policies allow you to accumulate non-consecutive

days toward satisfying the elimination period, and some policies require

consecutive days. Make sure you know how the policy defines the

elimination period.

During an elimination period, the policy will not pay the cost of long-term

care services. You may owe the cost of your care during the elimination

period. You may choose to pay a higher premium for a shorter elimination

period. If you choose a longer elimination period, you’ll pay a lower

premium but must pay the cost of your care during the elimination period.

For example, if a nursing home in your area costs $150 a day and your

policy has a 30-day elimination period, you’d have to pay $4,500 before

your policy starts to pay benefits. A policy with a 60-day elimination period

would mean you’d have to pay $9,000 of your own money, while a policy

with a 90-day elimination period would mean you’d have to pay $13,500 of

your own money.

If you only need care for a short time and your policy has a long

elimination period, your policy may not pay any benefits. If, for example,

your policy had a 100-day elimination period, and you received long-term

care services for only 60 days, you would not receive any benefits from

your policy.

On the other hand, if you can afford to pay for long-term care services for

a short time, a longer elimination period might be right for you. It would

protect you if you need extended care and also keep the cost of your

insurance down.

You may also want to think about how the policy pays if you have a repeat

stay in a nursing home. Some policies count the second stay as part of the

first one as long as you leave and then go back within 30, 90 or 180 days.

Find out if the insurance company requires another elimination period for a

second stay. Some policies only require you to meet the elimination period

once per lifetime.

What Happens When Long-Term Care Costs Rise

(Inflation Protection)?

Inflation protection can be one of the most important additions you can

make to a long-term care insurance policy. Inflation protection increases

the premium. However, unless your benefits increase over time, years from

now you may find that they haven’t kept up with the rising cost of long-

term care. The cost of nursing home care has been rising at an annual rate

of 5% for the past several years.

This means that a nursing home that

cost $150 a day in 2000 will cost $398 a day in 20 years, if inflation is 5%

a year. Obviously, the younger you are when you buy a policy, the more

important it is for you to think about adding inflation protection.

You can usually buy inflation protection in one of two ways: automatically

or by special offer.

Automatic Inflation Protection. The first way automatically increases your

benefits each year. Generally, there would be no increase in premium when

the benefit is automatically increased. Policies that increase benefits for

inflation automatically may use simple or compound rates. Either way, the

daily benefit increases each year by a fixed percentage, usually 5%, for the

life of the policy or for a certain period, usually 10 or 20 years.

The dollar amount of the increase depends on whether the inflation

adjustment is “simple” or “compound.” If the inflation increase is simple,

the benefit increases by the same dollar amount each year. If the increase

is compounded, the dollar amount of the benefit increase goes up each

year. For example, a $100 daily benefit that increases by a simple 5% a

year will go up $5 a year and will be $200 a day in 20 years. If the

increase is compounded, the annual increase will be higher each year and

the $100 daily benefit will be $265 a day in 20 years.

Automatic inflation increases that are compounded are a good idea, but not

all policies offer them. Some states now require policies to offer compound

inflation increases. Check with your state insurance department to find out

if this applies in your state. All individual and some group tax-qualified

policies must offer compound inflation increases as an option. Compounding

can make a big difference in the size of your benefit.

Effect of Inflation on Daily

Rates for Nursing Home Care

COMPOUND INTEREST

Rate of Inflation 2000 2005 2010 2015 2020

5% $150 $191 $244 $312 $398

6% $150 $201 $269 $359 $481

7% $150 $210 $295 $414 $580

8% $150 $220 $324 $476 $699

SIMPLE INTEREST

Rate of Inflation 2000 2005 2010 2015 2020

5% $150 $188 $225 $263 $300

6% $150 $195 $240 $285 $330

7% $150 $203 $255 $308 $360

8% $150 $210 $270 $330 $390

4823

Effect of Inflation on Daily

Rates for Nursing Home Care

These graphs are for demonstration purposes only. They show compounded and simple inflation increases over a

20-year period.

Special Offer or Non-Automatic Inflation Protection. The second way to buy

inflation protection lets you choose to increase your benefits periodically,

such as every two or three years. With a periodic increase option, you

usually don’t have to show proof of good health, if you regularly use the

option. Your premium will increase if you increase your benefits. How much

it increases depends on your age at the time and on the amount of

additional benefit you want to buy. Buying more benefits every few years

may help you afford the cost of the additional coverage. If you turn down

the option to increase your benefit one year, you may not get the chance

again. If you get the chance later, you may have to prove good health, or it

may cost you more money. If you don’t accept the offer, you need to check

your policy to see how it will affect future offers. Some policies continue the

inflation offers while you are receiving benefits, but most do not. So check

your policy carefully before you buy.

The above charts and graphs illustrate the effects of inflation in two

formats.

NOTE: Most states have adopted regulations that require companies

to offer inflation protection. It’s up to you to decide whether to buy

the coverage. If you decide not to take the protection, you may be

asked to sign a statement saying you didn’t want it. Be sure you

know what you’re signing.

Additional Benefits

Third Party Notice. This benefit lets you name someone whom the

insurance company would contact if your coverage is about to end because

you forgot to pay the premium. Sometimes people with cognitive

impairments forget to pay the premium and lose their coverage when they

need it the most.

You can choose a relative, friend or a professional (e.g., a lawyer or

accountant) as your third party. After the company contacts the person you

choose, he or she would have some time to arrange for payment of the

overdue premium. You can usually name a contact person without paying

extra. Some states require insurance companies to give you the chance to

name a contact and to update your list of contacts from time to time. You

may be required to sign a waiver if you choose not to name anyone to be

contacted if the policy is about to lapse.

Other Long-Term Care Insurance Policy Options You Might

Choose

You can probably choose other policy features, but keep in mind that not all

insurers offer all of the policy options. Each may add to the cost of your

policy. Ask your insurer what features increase your policy’s cost.

Waiver of Premium. Many policies automatically include this feature, but

some may only offer it as an additional optional benefit. Premium waiver

lets you stop paying the premium once you are eligible for benefits and the

insurance company has started to pay benefits. Some companies waive the

premium as soon as they make the first benefit payment. Others wait until

you have received benefits for 60 to 90 days.

Restoration of Benefits. This option gives you a way to keep the

maximum amount of your original benefit even after your policy has paid

you benefits. With this option, if you fully recover after a prior disability and

go for a stated period without needing or receiving more long-term care

services, your benefit goes back to the amount you first bought. For

example, assume your policy paid you $5,000 in long-term care benefits

out of a policy maximum of $75,000. You would have $70,000 in benefits

left. With a restoration of benefits option, if you fully recovered and didn’t

need or use any long-term care services for a specified time (usually 6

months), your maximum benefit would go back to the original $75,000.

Premium Refund At Death. This benefit pays to your estate any premiums

you paid minus any benefits the company paid. To get a refund at death,

you must have paid premiums for a certain number of years. Some

companies refund premiums only if the policyholder dies before a certain

age, usually 65 or 75. The premium refund option may also add to the cost

of a policy.

Downgrades. While it may not always appear in the contract, most

insurers let policyholders reduce their coverage if they have trouble paying

the premium. When you downgrade to a less comprehensive policy, you will

pay a lower premium, usually based on your age at the time your

purchased your original policy. This may allow you to keep the policy in

force instead of dropping it.

What Happens If You Cannot Afford the Premiums

Anymore?

Nonforfeiture Benefits. If, for whatever reason, you drop your coverage

and you have a nonforfeiture benefit in your policy, you will receive some

benefit value for the money you’ve paid into the policy. Without this type of

benefit, you get nothing, even if you’ve paid premiums for 10 or 20 years

before dropping the policy.

Some states may require insurance companies to offer long-term care

insurance policies with a written offer of nonforfeiture benefit. In this case,

you may be given benefit options with different premium costs, including

reduced paid-up policies, shortened benefit period policies and

extended term policies. Under these benefit options, when you stop

paying your premiums, the company gives you a paid-up policy. Depending

on the option you chose, your paid-up policy either will have the same

benefit period but with a lower daily benefit (reduced paid-up policy) or will

have the same daily benefit but with a shorter benefit period (shortened

benefit period policy or extended term policy). Under all of these options,

the level of benefits you will receive depends on how long you paid

premiums and the amount of premiums you have paid. Since it’s paid-up,

you won’t owe any more premiums.

Other insurers may offer a “return of premium” nonforfeiture benefit. They

pay back to you all or part of the premiums that you paid in if you drop

your policy after a certain number of years. This is generally the most

expensive type of nonforfeiture benefit. A nonforfeiture benefit can add

roughly 10% to 100% (and sometimes more) to a policy’s cost. How much

it adds depends on such things as your age at the time you bought the

policy, the type of nonforfeiture benefit, and whether the policy has inflation

protection.

You have the option to add a nonforfeiture benefit if you’re buying a tax-

qualified policy. The “return of premium” nonforfeiture benefit, the “reduced

paid-up policy” and the “shortened benefit period policy” may be available

options under a tax-qualified policy if you drop the policy. You should

consult a tax advisor to see if adding a nonforfeiture benefit would be good

for you.

Contingent Nonforfeiture. In some states, if you don’t accept the offer of

a nonforfeiture benefit, a company is required to provide a “contingent

benefit upon lapse.” This means that when your premiums increase to a

certain level (based on a table of increases), the “contingent benefit upon

lapse” will take effect. For example, if you bought the policy at age 70 and

did not accept the insurance company’s offer of a nonforfeiture benefit, if

the premium rises to 40% more than the original premium, you will be

offered the opportunity to accept one of the “contingent benefits upon

lapse.” The benefits offered are: 1) a reduction in the benefits provided by

the current policy so that premium costs stay the same; or 2) a conversion

of the policy to paid-up status with a shorter benefit period. You may also

choose to keep your policy and continue to pay the higher premium.

 Will Your Health Affect Your Ability to Buy a

Policy?

Companies that sell long-term care insurance medically “underwrite” their

coverage. They look at your health and health history before they decide to

issue a policy. You may be able to buy coverage through an employer or

another type of group without any health underwriting or with more relaxed

underwriting. Insurance companies’ underwriting practices affect the

premiums they charge you now and in the future. Some companies do what

is known as “short-form” underwriting. They ask you to answer a few

questions on the insurance application about your health. For example, they

may want to know if you have been in a nursing home or received care at

home in the last 12 months.

Sometimes companies don’t check your medical record until you file a

claim. Then they may try to refuse to pay you benefits because of

information found in your medical record after you file your claim. This

practice is called “post-claims underwriting.” It is illegal in many states.

Companies that thoroughly check your health before selling you a policy

aren’t as likely to do post-claims underwriting.

Some companies do more underwriting. They may ask more questions, look

at your current medical records, and ask your doctor for a statement about

your health. These companies may insure fewer people with health

problems. If you have certain conditions that are likely to mean you’ll soon

need long-term care (Parkinson’s disease, for example), you probably

cannot buy coverage from these companies.

No matter how the company underwrites, you must answer certain

questions that the company uses to decide if it will insure you. When you

fill out your application, be sure to answer all questions correctly and

completely. A company depends on the information you put on your

application. If the information is wrong, an insurance company may decide

to rescind your policy and return the premiums you have paid. It can

usually do this within two years after you buy the policy. Most states

require the insurance company to give you a copy of your application when

it delivers the policy. At this time, you can review your answers again. You

should keep this copy of the application with your insurance papers.

 What Happens If You Have Pre-Existing

Conditions?

A long-term care insurance policy usually defines a pre-existing condition as

one for which you received medical advice or treatment or had symptoms

of within a certain period before you applied for the policy. Some

companies look further back in time than others. That may be important to

you if you have a pre-existing condition. A company that learns you didn’t

tell it about a pre-existing condition on your application might not pay for

treatment related to that condition and might even cancel your coverage. A

company can usually do this within two years after you buy the policy, or in

some cases later, if you intentionally mislead the insurer.

Many companies will sell a policy to someone with a pre-existing condition.

However, the company may not pay benefits for long-term care related to

that condition for a period after the policy goes into effect, usually six

months. Some companies have longer pre-existing condition periods;

others have none.

 Can You Renew Your Long-Term Care Insurance

Policy?

In most states, long-term care insurance policies sold today must be

guaranteed renewable. When a policy is guaranteed renewable, it means

that the insurance company guarantees you a chance to renew the policy.

It does not mean that it guarantees you a chance to renew at the same

premium. Your premium may go up over time as your company pays more

claims and more expensive claims.

Insurance companies can raise the premiums on their policies, but only if

they increase the premiums on all policies that are the same in that state.

No individual can be singled out for a rate increase, no matter how

many claims have been filed. In some states, the premium cannot increase

just because you are older. If you bought a policy in a group setting and

you leave the group, you may be able to keep your group coverage or

convert it to an individual policy, but you may pay more. You can ask

your state insurance department if your state requires this option.

 How Much Do Long-Term Care Insurance

Policies Cost?

A long-term care insurance policy can be expensive. Be sure you can pay

the premiums and still afford your other health insurance and other

expenses.

Premiums will vary based on a variety of factors. These factors include your

age and health when you buy a policy and the level of coverage, benefits

and options you select for your policy. If you buy a policy with a large daily

benefit, a longer maximum benefit period, or a home health care benefit, it

will cost you more. Inflation protection and nonforfeiture benefits can

increase premiums for long-term care substantially.

Inflation protection can add 25% to 40% to the premium. Non-forfeiture

benefits can add 10% to 100% to the premium, as noted on page 25. In

fact, either of these options can easily double your premium, depending on

your age when you buy a policy. The older you are when you buy long-term

care insurance, the higher your premiums will be, as it’s more likely you

will need long-term care services. (See “Who May Need Long-Term Care” on

page 6.) If you buy at a younger age, your premiums will be lower, but you

will pay premiums for a longer period of time. Recent studies have found

the average age of purchasers was age 65 in the individual market and age

43 in the employer-sponsored market.

Here is an example of how much premiums can fluctuate based on your

age and your coverage options:

• The average annual premiums for basic long-term care insurance

($100 daily benefit amount, four years of coverage, and a 20-day

elimination period) that do not include a 5% compound inflation

protection option or a nonforfeiture

benefits option were:

- $300 for a 40-year-old.

- $409 for a 50-year-old.

- $1,002 for a 65-year-old.

- $4,166 for a 79-year-old.

• The average annual premiums for the same policy with the 5%

compound inflation protection option but no nonforfeiture benefit

option were:

- $649 for a 40-year-old.

- $881 for a 50-year-old.

- $1,802 for a 65-year-old.

- $5,895 for a 79-year-old.

• The average annual premiums for the same policy with the

nonforfeiture benefits option but no inflation protection were:

- $382 for a 40-year-old.

- $506 for a 50-year-old.

- $1,196 for a 65-year-old.

- $5,067 for a 79-year-old.

• The average annual premiums for the same policy with both the 5%

compound inflation protection option and the nonforfeiture benefits

option were:

- $798 for a 40-year-old.

- $1,087 for a 50-year-old.

- $2,130 for a 65-year-old.

- $7,000 for a 79-year-old.

Remember, your actual premium may be very different if it’s based

on other factors.

Another issue to keep in mind is that long-term care insurance policies may

not cover the entire cost of your care. For example, your policy may cover

$110 per day in a nursing home, but the total cost of care may be $150

per day. You must pay the difference. Remember, medications and

therapies will increase your total daily costs for care. The costs of long-term

care in your state should influence the amount of coverage you buy and the

premiums you will pay. (See “How Much Does Long-Term Care Cost?” on

page 2.)

When you buy a long-term care policy, think about how much your income

is and how much you could afford to spend on a long-term care insurance

policy now. Also try to think about what your future income and living

expenses are likely to be and how much premium you can pay then. If you

don’t expect your income to increase, it probably isn’t a good idea to buy a

policy if you can barely afford the premium now.

You also need to think about whether you could afford a rate increase on

your policy some time in the future. Remember, while a company cannot

raise your rates based on your age or health, the company can raise the

rates for an entire class of policies. Some states have laws that limit rate

increases. Check with your insurance department to learn how your

state regulates rate increases. A directory of state insurance

departments begins on page 60. Again, it probably isn’t a good idea to buy

a policy if you can barely afford the premium now.

NOTE: Don’t be misled by the term “level premium.” You may be told that your

long-term care insurance premium is “level.” That doesn’t mean that it will never

increase. Except for whole life insurance policies and noncancellable policies or

riders, companies cannot guarantee premiums will never increase. Many states

have adopted regulations that don’t let insurance companies use the word “level” to

sell guaranteed renewable policies. Companies must tell consumers that premiums

may go up. Look for that information on the outline of coverage and the policy’s

face page when you shop.

 What Options Do I Have to Pay the Premiums

on the Policy?

If you decide you can afford to buy a long-term care insurance policy, there

are two main ways in which you may be able to pay your premiums—the

continuous payment option and the limited payment option.

Under the continuous payment option, you would pay the premiums on

your policy until you trigger your benefits, traditionally on a monthly,

quarterly, semi-annual or annual basis. The policy is not cancelable except

in the event of nonpayment of premiums; however, the insurance company

can increase premiums on an entire class of policies. Premiums are usually

the lowest available under this payment option.

In addition to the continuous payment option, you may be able to pay your

premiums under a limited payment option. Under this option, you would

pay premiums for a set time period using one of the following ways:

• Single pay. This allows you to make one lump-sum payment.

• 10-pay and 20-pay. This allows you to complete payment of your

premiums in 10 or 20 years, depending on the option you choose.

You might choose this option if your income will be lower in 10 or 20

years.

• Pay-to-65. You pay higher-than-usual premiums, but payments end

when you reach age 65.

After the last premium payment, neither you nor the company can cancel

the policy. Policies with the limited payment option are more expensive

than continuous payment policies, because your premium is set at a higher

rate than it would have been had you paid over a longer period of time. In

addition, unless the contract fixes your premium for the pay period, it could

increase. However, the guaranteed fixed payment and the no-cancel

features make limited payment premiums attractive to some clients. You

should consult your tax advisor for information on the tax treatment of

accelerated premium payments.

It is important to note that not all of these payment options are offered by

all companies or are available in all states. Check with the insurance

company to see what payment options it offers. Also check with your

state insurance department to find out what options your state

allows. A directory of state insurance departments begins on page 60.

 If You Already Own a Policy, Should You Switch

Plans or Upgrade the Coverage You Have Now?

Before you switch to a new long-term care insurance policy, make sure it is

better than the one you already have. Even if your agent now works for

another company, think carefully before making any changes. First check to

see if you can upgrade the coverage on your current policy. If not, you may

replace your current policy with a different one that gives you more

benefits, or even choose a second policy. Be sure to discuss any change in

your coverage with your financial advisor.

If you decide to switch to a new long-term care insurance policy,

make sure the new company has accepted your application and

issued the new policy before you cancel the old one. When you cancel

a policy in the middle of its term, many companies will not give back any

premiums you have paid. If you switch policies, new restrictions on pre-

existing conditions may apply. You may not have coverage for some

conditions for a certain period.

Switching may be right for you if your old policy requires you to stay in the

hospital or to receive other types of care before it pays benefits. Before you

decide to change, though, make sure you are in good health and can

qualify for another policy. If you bought a policy when you were younger,

you might ask the insurance company if you can improve it. For example,

you might add inflation protection or take off the requirement that you stay

in the hospital. It might cost less to improve a policy you have now than to

buy a new one.

 What Shopping Tips Should You Keep in Mind?

Here are some points to keep in mind as you shop.

Ask questions.

If you have questions about the agent, the insurance company or the

policy, contact your state insurance department or insurance

counseling program. (A directory starts on page 60.) Make sure the

company is reputable and is licensed to sell long-term care insurance

policies in your state.

Check with several companies and agents.

Contacting several companies (and agents) before you buy is wise. Be sure

to compare benefits, the types of facilities you have to be in to get

coverage, the limits on your coverage, what’s excluded, and, of course, the

premium. (Policies that have the same coverage and benefits may not cost

the same.)

Check out the companies’ rate increase histories.

Ask companies about their rate increase histories and whether they have

increased the rates on the long-term care insurance policies that they sell.

Ask to see a company’s personal worksheet that includes this information.

Some state insurance commissioners annually prepare a consumer rate

guide for long-term care insurance. These guides may include an overview

of long-term care insurance, a list of companies selling long-term care

insurance in your state, the types of benefits and policies you can buy

(both as an individual and as a member of a group), and a rate history of

each company that sells long-term care insurance in your state. Some

guides even include examples of different coverage types and combinations

and provide rates to assist consumers in comparing policies. Contact your

state insurance department or insurance counseling program for

this information. A list of insurance departments and counseling programs

starts on page 60.

Take your time and compare outlines of coverage.

Never let anyone pressure or scare you into making a quick decision. Don’t

buy a policy the first time you see an agent. Ask for an outline of coverage.

It outlines the policy’s benefits and points out important features. Compare

outlines of coverage for several policies, and make sure the outlines are

similar (if not the same) when comparing premiums. In most states the

agent must leave an outline of coverage when he or she first contacts you.

Understand the policies.

Make sure you know what the policy covers and what it doesn’t. If you

have any questions, call the insurance company before you buy.

If you receive any information that confuses you or is different from the

information in the company literature, don’t hesitate to call or write the

company to ask your questions. Don’t trust any sales presentation or

literature that claims you have only one chance to buy a policy.

Some companies sell their policies through agents, and others may sell

their policies through the mail, skipping agents entirely. No matter how you

buy your policy, check with the company if you don’t understand how the

policy works.

Talk about the policy with a friend or relative. You may also want to

contact your state insurance department or insurance counseling

program. A list of insurance departments and counseling programs starts

on page 60.

Don’t be misled by advertising.

Most celebrity endorsers are professional actors paid to advertise. They are

not insurance experts. Medicare does not endorse or sell long-term care

insurance policies. Be wary of any advertising that suggests Medicare is

involved.

Don’t trust cards you get in the mail that look like official government

documents until you check with the government agency identified on the

card. Insurance companies or agents trying to find buyers may have sent

them. Be careful if anyone asks you questions over the telephone about

Medicare or your insurance. They may sell any information you give to

long-term care insurance marketers, who might call you, come to your

home or try to sell you insurance by mail.

Don’t buy more coverage than you need.

You don’t have to buy more than one policy to get enough coverage. One

good policy is enough. Also, don’t buy more insurance than you need. For

example, buying a policy with a $500 daily benefit in order to prepare for

inflation is not necessary. You should choose the daily benefit that matches

the cost of long-term care. For more information, reread the section “If You

Already Own a Policy, Should You Switch Plans or Upgrade the Coverage

You Have Now?” on page 31. Be sure to discuss any change in your

coverage with your financial advisor.

Be sure you accurately complete your application.

Don’t be misled by long-term care insurance marketers who say your

medical history isn’t important—it is! Give correct information. If an agent

fills out the application for you, don’t sign it until you have read it. Make

sure that all of the medical information is accurate and complete. If it isn’t

and the company used that information to decide whether to insure you, it

can refuse to pay your claims and can even cancel your policy.

Never pay in cash.

Use a check or an electronic bank draft made payable to the insurance

company.

Be sure to get the name, address, and telephone number

of the agent and the company.

Get a local or toll-free number for both the agent and the company.

If you don’t get your policy within 60 days, contact the

company or agent.

You have a right to expect prompt delivery of your policy. When you get it,

keep it somewhere you can easily find it. Tell a trusted friend or relative

where it is.

Be sure you look at your policy during the free-look

period.

If you decide you don’t want the policy soon after you bought it, you can

cancel it and get your money back. You must tell the company you don’t

want the policy within a certain number of days after you get it. How many

days you have depends on the “free-look” period. In some states the

insurance company must tell you about the free-look period on the cover

page of the policy. In most states you have 30 days to cancel, but in some

you have less time. Check with your state insurance department to

find out how long the free-look period is in your state.

If you want to cancel:

• Keep the envelope the policy was mailed in. Or ask the agent for a

signed delivery receipt when he or she hands you the policy.

• Send the policy to the insurance company along with a short letter

asking for a refund.

• Send both the policy and the letter by certified mail. Keep the mailing

receipt.

• Keep a copy of all letters. It usually takes four to six weeks to get

your refund.

Read the policy again and make

sure it gives you the coverage

you want.

Check the policy to see if the benefits and

the premiums are what you expected. If

you have any questions, call the agent or

company right away. Also, reread the

application you signed. It is part of the

policy. If it’s not filled out correctly, contact

the agent or company right away. You may

want to fill out Worksheet 3 on page 52.

Think about having the premium

automatically taken out of your

bank account.

Automatic withdrawal may mean that you won’t lose your coverage if an

illness makes you forget to pay your premium. If you decide not to renew

your policy, be sure you tell the bank to stop the automatic withdrawals.

Check on the financial stability of the company you’re

thinking about buying from.

Several insurer rating services analyze the financial strength of insurance

companies. The ratings can show you how some analysts see the financial

health of individual insurance companies. Different rating services use

different rating scales. Be sure to find out how the agency labels its highest

ratings and the meaning of the ratings for the companies you are

considering.

You can get ratings from some insurer rating services for free at most

public libraries. Or you can call the services directly at the numbers listed

below. (Note that calls to a “900” number will mean an extra charge on

your telephone bill.) And now you can get information from these services

on the Internet.

Rating Agencies

• A.M. Best Company

(900) 439-2200 (billed to telephone) or (800) 424-BEST (charged to

credit card) or on the Internet at www.ambest.com

• Fitch IBCA, Duff & Phelps, Inc.

(212) 908-0800 or on the Internet at www.fitchrating.com

• Moody’s Investor Service, Inc.

(212) 553-0377 or on the Internet at www.moodys.com

• Standard & Poor’s Insurance Rating Services

(212) 438-2400 or on the Internet at www.standardandpoors.com

• Weiss Ratings, Inc.

(800) 289-9222 or on the Internet at www.WeissRatings.com

 References

1 http://www.longtermcare.gov/LTC/Main_Site/Paying _LTC/Costs_Of_Care/Costs_Of_Care.aspx.

2 http://www.longtermcare.gov/LTC/Main_Site/Paying _LTC/Costs_Of_Care/Costs_Of_Care.aspx.

3 http://www.longtermcare.gov/LTC/Main_Site/Paying _LTC/Costs_Of_Care/Costs_Of_Care.aspx.

4 http://ltc.georgetown.edu/pdfs/nursinghomecosts.pdf?wwparam+1204931144. Still less than

10% in 2003.

5 Centers for Medicaid and Medicare Services, Medicare & You 2008 Guide.

6 Centers for Medicaid and Medicare Services, 2008 Guide to Health Insurance for People with

Medicare, page 25.

7 CMS National Health Expenditures, January 2002. Medicaid pays for 48% of all nursing home

care.

8 Omnibus Budget Reconciliation Act of 1993 (OBRA). OBRA requires each state to have an “Estate

Recovery Program,” which is designed to recover the costs of Medicaid-paid benefits from that

person’s estate or the estate of his or her spouse. If you are age 55 or over and receive Medicaid

benefits for nursing home care and related services, OBRA requires that states recover the paid

benefits in an amount equal to the total of the assistance provided from your estate. This could

include your home and any other property that otherwise would be passed to your heirs.

9 The Older Population, A Profile of Older Americans: 2001, Administration on Aging. Information

in profile based on data gathered in the 2000 U.S. Census.

10 National Academy on Aging, 1997.

11 Stillman and Lubitz, “Medical Care” 40 (10): 965-967 (2002).

12 Stillman and Lubitz, “Medical Care” 40 (10): 965-967 (2002).

13 Rogers, S. & H. Komisar. Who Needs Long-Term Care? Fact Sheet: Long-Term Care Financing

Project. Washington, D.C.: Georgetown University Press, 2003.

14 AARP. Beyond 50.03: A Report to the Nation on Independent Living and Disability, 2003.

15 U.S. Department of Health and Human Services and U.S. Department of Labor. The future

supply of long-term care workers in relation to the aging baby boom generation. Report to

Congress. Office of the Assistant Secretary for Planning and Evaluation, 2003.

16 Health Insurance Association of America Survey. “Research Findings: Long-Term Care Insurance

in 1998-1999,” February 2002, pages 3, 5, 13, 17, 27. The employer-sponsored market

contributed 25% of the sales in 1999. By the end of 1999, more than 1 million policies had been

sold through more than 3,200 employers. This represents 35% average growth rate. There were

more than 770 employer-sponsored plans introduced in 1999 alone.

17 Members of the federal family can obtain information on this program from the United States

Office of Personnel Management by calling the toll-free number 1-800-582-3337 or by accessing

the Web site http://www.opm.gov/insure/lte/

18 Internal Revenue Service, Revenue Procedure 97-57, adjusted to 2008 tax deductible limits.

19 U.S. Department of Labor, Bureau of Labor Statistics, 2000. Data shows that between 1995 and

2001, the average nursing home costs have risen about 5%.

20 Health Insurance Association of America (HIAA) Survey. “Research Findings: Long-Term Care

Insurance in 1998 1999,” February 2002.

21 Health Insurance Association of America (HIAA) Survey. ‘Research Findings: Long-Term Care

Insurance in 1998 1999,” February 2002. Table 5. p. 26. “Average Annual Premiums for Leading

Long-Term Care Insurance Sellers in 1999.”

 Glossary

Accelerated Death Benefit

A feature of a life insurance policy that lets you use some of the policy’s

death benefit prior to death.

Activities of Daily Living

(ADLs)

Everyday functions and activities individuals usually do without help. ADL

functions include bathing, continence, dressing, eating, toileting and

transferring. Many policies use the inability to do a certain number of ADLs

(such as two of six) to decide when to pay benefits.

Adult Day Care

Care provided during the day at a community-based center for adults who

need assistance or supervision during the day, including help with personal

care, but who do not need round-the-clock care.

Alzheimer’s Disease

A progressive, degenerative form of dementia that causes severe

intellectual deterioration.

Assisted Living Facility

A residential living arrangement that provides individualized personal care

and health services for people who require assistance with activities of daily

living. The types and sizes of facilities vary; they can range from a small

home to a large apartment-style complex. They also vary in the levels of

care and services that can be provided. Assisted living facilities offer a way

to keep a relatively independent lifestyle for people who don’t need the

level of care provided by nursing homes.

Bathing

Washing oneself by sponge bath, in either a tub or shower. This activity

includes the task of getting into or out of the tub or shower.

Benefit Triggers

(Triggers)

Term used by insurance companies to describe the criteria and methods

they use to determine when you are eligible to receive benefits.

Benefits

Monetary sum paid or payable to a recipient for which the insurance

company has received the premiums.

Care Management Services

A service in which a professional, typically a nurse or social worker, may

arrange, monitor or coordinate long-term care services (also referred to as

care coordination services).

Cash Surrender Value

The amount of money you may be entitled to receive from the insurance

company when you terminate a life insurance or annuity policy. The amount

of cash value will be determined as stated in the policy.

Chronic Illness

An illness with one or more of the following characteristics: permanency,

residual disability, requires rehabilitation training, or requires a long period

of supervision, observation or care.

Chronically Ill

A term used in a tax-qualified long-term care contract to describe a person

who needs long-term care either because of an inability to do everyday

activities of daily living (ADLs) without help or because of a severe

cognitive impairment.

Cognitive Impairment

A deficiency in a person’s short- or long-term memory; orientation as to

person, place and time; deductive or abstract reasoning; or judgment as it

relates to safety awareness.

Community-Based Services

Services designed to help older people stay independent and in their own

homes.

Continence

The ability to maintain control of bowel and bladder function; or when

unable to maintain control of these functions, the ability to perform

associated personal hygiene (including caring for catheter or colostomy

bag).

Continuing Care Retirement Communities

(CCRC)

A retirement complex that offers a broad range of services and levels of

care.

Continuous Payment Option

A premium payment option that requires you to pay premiums until you

trigger your benefits. Premiums are usually paid on a monthly, quarterly,

semi-annual or annual basis. The policy is not cancelable except when

premiums aren’t paid; however, the insurance company can increase

premiums on an entire class of policies. Premiums are usually the lowest

available.

Custodial Care

(Personal Care)

Care to help individuals meet personal needs such as bathing, dressing and

eating. Someone without professional training may provide care.

Medicaid

A joint federal/state program that pays for health care services for those with

low incomes or very high medical bills relative to income and assets.

Medicare

The federal program providing hospital and medical insurance to people aged

65 or older and to certain ill or disabled persons. Benefits for nursing home and

home health services are limited.

Medicare Supplement Insurance

A private insurance policy that covers many of the gaps in Medicare coverage

(also called Medigap insurance coverage).

National Association of Insurance Commissioners

(NAIC)

Membership organization of state insurance commissioners. One of its goals is

to promote uniformity of state regulation and legislation related to insurance.

Noncancelable Policies

Insurance contracts that cannot be cancelled by the insurance company and

the rates cannot be changed by the insurance company.

Nonforfeiture Benefits

A policy feature that returns at least part of the premiums to you if you cancel

your policy or let it lapse.

Nursing Home

A licensed facility that provides general nursing care to those who are

chronically ill or unable to take care of daily living needs. May also be referred

to as a Long-Term Care Facility.

Paid-up Policy

When you prematurely stop paying your premiums, your insurance policy is

deemed to be paid-in-full. You do not pay any more premiums, but the benefits

you receive under this policy will be determined based on the amount of

premiums you have already paid, not on the level of benefits that you originally

purchased.

Partnership Policy

A type of policy that allows you to protect (keep) some of your assets if you

apply for Medicaid after using your policy’s benefits. Not all states have these

policies.

Personal Care

(Custodial care)

Care to help individuals meet personal needs such as bathing, dressing and

eating. Someone without professional training may provide care.

Personal Care Home

A general term for a facility that cares for elderly people. It is often not

covered under a long-term care policy.

Daily Benefit

The amount of insurance benefit in dollars a person chooses to buy for

long-term care expenses.

Dementia

Deterioration of intellectual faculties due to a disorder of the brain.

Disability Method

Method of paying benefits that only requires you to meet the benefit

eligibility criteria. Once you do, you receive your full daily benefit.

Dressing

Putting on and taking off all items of clothing and any necessary braces,

fasteners or artificial limbs.

Eating

Feeding oneself by getting food into the body from a receptacle (such as a

plate, cup or table) or by a feeding tube or intravenously.

Elimination Period

A type of deductible; the length of time the individual must pay for covered

services before the insurance company will begin to make payments. The

longer the elimination period in a policy, the lower the premium.

Sometimes also called a “waiting period.”

Expense-Incurred Method

Method of paying benefits where the insurance company must decide if you

are eligible for benefits and if your claim is for eligible services. Your policy

or certificate will pay benefits only when you receive eligible services. Once

you have incurred an expense for an eligible service, benefits are paid

either to you or your provider. The coverage will pay for the lesser of the

expense you incurred or the dollar limit of your policy. Most policies bought

today pay benefits using the expense-incurred method.

Extended Term Benefits

Full benefits for a reduced time period, applicable for use during a certain

period of time. If not used in a set number of years after the lapse, then

you lose it. Once the period has expired, the contract terminates.

Guaranteed Renewable

When a policy cannot be cancelled by an insurance company and must be

renewed when it expires unless benefits have been exhausted. The

company cannot change the coverage or refuse to renew the coverage for

other than nonpayment of premiums (including health conditions and/or

marital or employment status). In a guaranteed renewable policy, the

insurance company may increase premiums, but only on an entire class of

policies, not just on your policy.

Hands-On Assistance

Physical assistance (minimal, moderate or maximal) without which the

individual would not be able to perform the activities of daily living.

Health Insurance Portability and Accountability Act

(HIPAA)

Federal health insurance legislation passed in 1996 that allows, under

specified conditions, long-term care insurance policies to be qualified for

certain tax benefits.

Home Health Care

Services for nursing care or occupational, physical, respiratory or speech

therapy. Also included are medical, social worker, home health aide, and

homemaker services.

Homemaker Services

Household services done by someone other than yourself because you’re

unable to do them.

Home for the Aged

A general term for a facility that cares for elderly people. It is often not

covered under a long-term care policy.

Hospice Care

Continuous care provided at home or in a facility with a home-like setting

for a terminally ill person. A terminally ill person has a life expectancy of

six months or less.

Indemnity Method

Method of paying benefits where the benefit is a set dollar amount and is

not based on the specific service received or on the expenses incurred. The

insurance company only needs to decide if you are eligible for benefits.

Once the company determines you are eligible and you are receiving

eligible long-term care services, the insurance company will pay that set

amount directly to you up to the limit of the policy.

Inflation Protection

A policy option that provides for increases in benefit levels to help pay for

expected increases in the costs of long-term care services.

Lapse

Termination of a policy when a renewal premium is not paid.

Limited Payment Option

A premium payment option in which the person pays premiums for a set

time period. After the last premium payment, neither the company nor the

person can cancel the policy. These plans are more expensive than

continuous payment policies; however, their guaranteed fixed payment and

no-cancel features make them attractive to some people.

Medicaid

A joint federal/state program that pays for health care services for those with

low incomes or very high medical bills relative to income and assets.

Medicare

The federal program providing hospital and medical insurance to people aged

65 or older and to certain ill or disabled persons. Benefits for nursing home and

home health services are limited.

Medicare Supplement Insurance

A private insurance policy that covers many of the gaps in Medicare coverage

(also called Medigap insurance coverage).

National Association of Insurance Commissioners

(NAIC)

Membership organization of state insurance commissioners. One of its goals is

to promote uniformity of state regulation and legislation related to insurance.

Noncancelable Policies

Insurance contracts that cannot be cancelled by the insurance company and

the rates cannot be changed by the insurance company.

Nonforfeiture Benefits

A policy feature that returns at least part of the premiums to you if you cancel

your policy or let it lapse.

Nursing Home

A licensed facility that provides general nursing care to those who are

chronically ill or unable to take care of daily living needs. May also be referred

to as a Long-Term Care Facility.

Paid-up Policy

When you prematurely stop paying your premiums, your insurance policy is

deemed to be paid-in-full. You do not pay any more premiums, but the benefits

you receive under this policy will be determined based on the amount of

premiums you have already paid, not on the level of benefits that you originally

purchased.

Partnership Policy

A type of policy that allows you to protect (keep) some of your assets if you

apply for Medicaid after using your policy’s benefits. Not all states have these

policies.

Personal Care

(Custodial care)

Care to help individuals meet personal needs such as bathing, dressing and

eating. Someone without professional training may provide care.

Personal Care Home

A general term for a facility that cares for elderly people. It is often not

covered under a long-term care policy.

Pre-existing Condition

Illnesses or disability for which you were treated or advised within a time

period before applying for a life or health insurance policy.

Reduced Paid-up Benefits

A nonforfeiture option that reduces your daily benefit but retains the full

benefit period on your policy until death. For example, you buy a policy for

three years of coverage with a $150 daily benefit. Then if you let the policy

lapse, the daily benefit will be reduced to $100. The exact amount of the

reduction depends upon how much premium you have paid on the policy. The

benefit period on your policy continues to be three years. Unlike extended

term benefits, which must be used in a certain amount of time after the lapse,

you can use reduced paid-up benefits at any time after you lapse (until

death).

Rescind

When the insurance company voids (cancels) a policy.

Respite Care

Care provided by a third party that relieves family caregivers for a few hours

to several days and gives them an occasional break from daily caregiving

responsibilities.

Rest Home

A general term for a facility that cares for elderly people. It is often not

covered under a long-term care policy.

Rider

Addition to an insurance policy that changes the provisions of the policy.

Shortened Benefit Period

A nonforfeiture option that reduces the benefit period but retains the full daily

maximums applicable until death. The period of time for which benefits are

paid will be shorter. For example, you buy a policy for three years of coverage

with a $150 daily benefit, but if you let the policy lapse, the benefit period is

reduced to one year, with full daily benefits paid. The exact amount of the

reduction depends upon how much premium you have paid on the policy.

Unlike extended term benefits, which must be used in a certain amount of

time after the lapse, you can use shortened benefits at any time after you let

the premium lapse (until death).

Skilled Care

Daily nursing and rehabilitative care that can be performed only by, or under

the supervision of, skilled medical personnel. This care is usually needed 24

hours a day, must be ordered by a physician, and must follow a plan of care.

Individuals usually get skilled care in a nursing home but may also receive it

in other places.

Spend Down

A requirement that an individual use up most of his or her income and

assets to meet Medicaid eligibility requirements.

Stand-by Assistance

Caregiver stays close to the individual to watch over the individual and to

provide physical assistance if necessary.

State Health Insurance Program

Federally funded program to train volunteers to provide counseling on the

insurance needs of senior citizens. See pages 54-62 for a list of State

Health Insurance Programs.

Substantial Assistance

Hands-on or stand-by help required to do ADLs.

Substantial Supervision

The presence of a person directing and watching over another who has a

cognitive impairment.

Tax-Qualified Long-Term Care Insurance Policy

A policy that conforms to certain standards in federal law and offers certain

federal tax advantages.

Term Life Insurance

Covers a person for a period of one or more years. It pays a death benefit

only if you die during that term. It generally does not build a cash value.

Third Party Notice

A benefit that lets you name someone whom the insurance company would

notify if your coverage is about to end because the premium hasn’t been

paid. This can be a relative, friend or professional such as a lawyer or

accountant.

Toileting

Getting to and from the toilet, getting on and off the toilet and performing

associated personal hygiene.

Transferring

Moving into and out of a bed, chair or wheelchair.

Triggers

(Benefit Triggers)

Term used by insurance companies to describe when to pay benefits.

Underwriting

The process of examining, accepting or rejecting insurance risks, and

classifying those selected, to charge the proper premium for each.

Universal Life Insurance

A kind of flexible policy that lets you vary your premium payments and

adjust the face amount of your coverage.

Waiver of Premium

A provision in an insurance policy that relieves the insured of paying the

premiums while receiving benefits.

Whole Life Insurance

Policies that build cash value and cover a person for as long as he or she

lives if premiums continue to be paid.

 Worksheet 1

Information About the Availability and

Cost of Long-Term Care in Your Area

Find out what facilities and services provide long-term care in your area (or in

the area where you would be most likely to receive care) and what the costs are

for these services. List the information below.

Home Health Agency

Name of one

Home Health Agency

Address

Phone Number

Contact Person

Name of another

Home Health Agency

Address

Phone Number

Contact Person

Check which types of care are available and list the cost

 Skilled Nursing Care

Cost/Visit: $

 Home Health Care

Cost/Visit: $

 Personal/Custodial Care

Cost/Visit: $

 Homemaker Services

Cost/Visit: $

 Skilled Nursing Care

Cost/Visit: $

 Home Health Care

Cost/Visit: $

 Personal/Custodial Care

Cost/Visit: $

 Homemaker Services

Cost/Visit: $

Nursing Facility

Name of one

Nursing Facility

Address

Phone Number

Contact Person

Name of another

Nursing Facility

Address

Phone Number

Contact Person

Check which types of care are available and list the cost

 Skilled Nursing Care

Cost/Visit: $

 Personal/Custodial Care

Cost/Visit: $

 Skilled Nursing Care

Cost/Visit: $

 Personal/Custodial Care

Cost/Visit: $

Other Facility

(e.g. adult day care center, assisted living, etc.)

Name of Facility

Address

Phone Number

Contact Person

What services are available?

What are the costs for those services?

Name of Facility

Address

Phone Number

Contact Person

What services are available?

What are the costs for those services?

_________ _________

 Worksheet 2

How to Compare Long-Term Care Insurance Policies

Fill in the information below so that you can compare long-term care insurance

policies. Most of the information you need is in the outline of coverage provided

in the policies you are comparing. Even so, you will need to calculate some

information and talk to the agent or a company representative to get the rest.

(Refer to Page 16)

Policy 1 Policy 2

Insurance Company Information

1. Name of the insurance company’s agent

2. Is the company licensed in your state? Yes No Yes No

3. Insurance rating service and rating

(Refer to Page 35)

What levels of care are covered by this policy?

4. Does the policy provide benefits for these levels

of care?

• Skilled nursing care? Yes No Yes No

• Personal/Custodial Care?

(In many states, both levels of care are required)

Yes No Yes No

5. Does the policy pay for any nursing home stay, no

matter what level of care you receive? Yes No Yes No

• If not, what levels aren’t covered?

Where can you receive care covered under the

policy?

(Refer to Page 16)

6. Does the policy pay for care in any licensed facility? Yes No Yes No

• If not, what doesn’t it pay for?

7. Does the policy provide home care benefits for:

• Skilled nursing care? Yes No Yes No

• Personal care given by home health aides? Yes No Yes No

• Homemaker services? Yes No Yes No

• Other ________________________? Yes No Yes No

8. Does the policy pay for care received in:

• Adult day care centers? Yes No Yes No

• Assisted living facilities? Yes No Yes No

• Other settings? (list)

_________ _________

_____ _____

_________ _________

_____ _____

________ ________

_____ _____

Policy 1 Policy 2

How long are benefits paid and what amounts

are covered?*

(Refer to page 17-18)

9. How much will the policy pay per day for:

• nursing home care?

• assisted living facility care?

• home care?

10. Are there limits on the number of days or visits

per year for which benefits will be paid? Yes No Yes No

If yes, what are the limits for:

• nursing home care? days days

• assisted living facility care?

• home care?

(days or visits?) years years

11. What is the length of the benefit period that you

are considering? $ $

12. Are there limits on the amounts the policy will

pay during your lifetime? Yes No Yes No

If yes, what are the limits for:

• nursing home care? $ $

• assisted living facility care? $ $

• home care?

(days or visits?) $

• total lifetime limit $

How does the policy decide when you are eligible

for benefits?

(Refer to page 19)

13. Which of the “benefit triggers” does the policy

use to decide your eligibility for benefits?

(It may have more than one)

• unable to do activities of daily living (ADLs) Yes No Yes No

• cognitive impairment

(older policies may

discriminate against Alzheimer’s; newer ones don’t)

Yes No Yes No

• doctor certification of medical necessity Yes No Yes No

• prior hospital stay Yes No Yes No

• bathing is one of the ADLs Yes No Yes No

When do benefits start?

(Refer to page 20)

14. How long is the waiting period before benefits begin for:

• nursing home care? days days

• assisted living care? days days

* You may be considering a policy that pays benefits on a different basis, so you may have to do some calculations to determine

comparable amounts.

_____ _____

__ __

___ ___

_________ _________

________ ________

_________ _________

_______ _______

_________ _________

________ ________

Policy 1 Policy 2

• home health care? days days

• waiting period

(service days or calendar days)? service days service days

15. Are the waiting periods for home care cumulative

or consecutive? months months

16. How long will it be before you are covered for a

pre-existing condition?

(Usually 6 months) months months

17. How long will the company look back on your

medical history to determine a pre-existing

condition?

(Usually 6 months) months

months

Does the policy have inflation protection?

(Refer to page 21)

18. Are the benefits adjusted for inflation? Yes No

Yes

19. Are you allowed to buy more coverage?

If yes,

Yes No

Yes

• When can you by more coverage?

• How much can you buy? $

• When can you no longer buy more coverage?

20. Do the benefits increase automatically?

If yes,

Yes No

Yes

• What is the rate of increase? %

• Is it a simple or compound increase?

• When do automatic increases stop?

21. If you buy inflation coverage, what daily benefit

would you receive for:

Nursing home care

• 5 years from now? $

• 10 years from now? $

Assisted living facility care

• 5 years from now? $

• 10 years from now? $

Home health care

• 5 years from now? $

• 10 years from now? $

Policy 1 Policy 2

22. If you buy inflation coverage, what will your

premium be:

• 5 years from now? $ $

• 10 years from now? $ $

• 15 years from now? $ $

23. Is there a waiver of premium benefit?

(Refer to Page 24)

Yes No Yes No

If yes,

• How long do you have to be in a nursing

home before it begins?

• Does the waiver apply when you receive

home care? Yes No Yes No

24. Does the policy have a nonforfeiture benefit? Yes No Yes No

If yes, what kind?

(Refer to Page 25)

25. Does the policy have a return of premium benefit?

(Refer to Page 25)

Yes No Yes No

26. Does the policy have a death benefit? Yes No Yes No

If yes, are there any restrictions before the benefit

is paid?

(Refer to Page 24) Yes No

Yes

27. Will the policy cover one person or two? One Two

One

Two

Tax-qualified status

28. Is the policy tax-qualified?

(Refer to Page 11) Yes No Yes No

What does the policy cost?

(Refer to Page 12)

29. What is the premium excluding all riders?

• monthly $ $

• yearly $ $

30. What is the premium if home care is covered?

• monthly $ $

• yearly $ $

31. What is the premium if assisted living is covered?

• monthly $ $

• yearly $ $

Policy 1 Policy 2

32. What is the premium if you include an

inflation rider?

• monthly $ $

• yearly $ $

33. What is the premium benefit if you include a

nonforfeiture benefit?

• monthly $ $

• yearly $ $

34. Is there any discount if you and your spouse

both buy policies? Yes No Yes No

• If yes, what is the amount of the discount? $ $

• Do you lose the discount when one spouse

dies? Yes No Yes No

35. What is the total annual premium including all

riders and discounts?

• total monthly premium $ $

• total annual premium $ $

36. When looking at the results of Questions 29

through 35, how much do you think you are

willing to pay in premiums? $ $

___

_________________________________________________

__________________________________________________

_______________________________________________________

__________________________________________________

_________________________________________________

______________________________________________

_________________________________________________

_______________________________________________________

___

____________

___

______________________________________________

 Worksheet 3

Facts About Your Long-Term Care Insurance Policy

For use after you buy a long-term care policy. Fill out this form and put it with

your important papers. You may want to make a copy for a friend or a relative.

1. Insurance Policy Date

Policy Number

Date Purchased

Annual Premium $

2. Insurance Company Information

Name of Company

Address

Phone Number

3. Agent Information

Agent’s Name

Address

Phone Number

4. Type of Long-Term Care Policy

Nursing home only

Facilities only

Homecare only

Comprehensive

(nursing home, assisted living, home and community care)

Other

Tax-qualified

5. How long is the waiting period before benefits begin?

6. How do I file a claim

(Check all that apply)

I need prior approval

Fill out a claim form

Doctor notifies the company

Assessment by care manager

Contact the company

Submit a plan of care

Assessment by company

__________________________________________________

_______________________________________________________

_________________________________________________________

_______________________________________________

______________________

____________________________________________

__________________________________________________

_______________________________________________

___

__________________________________________________

___

_______________________________________________________

_________________________________________________________

________________________________________________

___

_______________________________________________________

7. How often do I pay premiums:

Annually

Semi-annually

Other, Specify:

8. The person to be notified if I forget to pay the premium

Name

Address

Phone number

9. Are my premiums deducted from my bank account?

Yes

Name of my bank

Address

Phone number

Bank account number

10. Where do I keep this long-term care policy?

Other information

11. Friend or relative who knows where my policy is:

Name

Address

Phone number

__________________

_________ _________

 Worksheet 4

Long-Term Care Riders To Life Insurance Policies

The purpose of this worksheet is to help you to evaluate one or more life long-

term care insurance policies. Fill out the form so you can compare your options.

In addition, you will want to fill out Worksheet 2 regarding the long-term care

benefits provided by the policy.

Policy 1 Policy 2

Life Insurance Company Information

1. Name of the insurance company’s agent

2. Is the company licensed in your state? Yes No Yes No

3. Insurance rating service and rating

(Refer to Page 35)

Policy Information?

4. What kind of life insurance policy is it?

• Whole life insurance Yes No Yes No

• Universal life insurance Yes No Yes No

• Term life insurance Yes No Yes No

5. What is the policy’s premium?

6. How often is the policy’s premium paid?

• One time/single premium Yes No Yes No

• Annually for life Yes No Yes No

• Annually for 10 years only Yes No Yes No

• Annually for 20 years only Yes No Yes No

• Other

7. Is there a separate premium for the long-term

care benefit provided by the life insurance policy? Yes No Yes No

If not, how is the premium paid?

• Included in life insurance premium? Yes No Yes No

• Deducted from the cash value of the

insurance policy? Yes No Yes No

8. How many people will the policy cover?

_________ _________

Policy 1 Policy 2

9. Will the payment of long-term care benefits

decrease the death benefit and cash value of

the policy? Yes No Yes No

10. Will an outstanding loan affect the long-term

care benefits? Yes No Yes No

11. Did you receive an illustration of guaranteed

values? Yes No Yes No

If yes, do the policy values equal zero at some age

on a guaranteed or midpoint basis? Yes No Yes No

If so, at what age?

_________________________

___________________

_________

________________________________________________

_______________________

 Long-Term Care Insurance Personal Worksheet

People buy long-term care insurance for many reasons. Some don’t want to use

their own assets to pay for long-term care. Some buy insurance to make sure

they can choose the type of care they get. Others don’t want their family to have

to pay for care or don’t want to go on Medicaid. But long-term care insurance

may be expensive, and may not be right for everyone.

By state law, the insurance company must fill out part of the information on this

worksheet and ask you to fill out the rest to help you and the company decide if

you should buy this policy.

Premium Information

Policy Form Numbers

The premium for the coverage you are considering will be [$ per month,

or $ per year,] [a one-time single premium of $ .]

Type of Policy

(noncancellable/guaranteed renewable):

The Company’s Right to Increase Premiums:

[The company cannot raise your rates on this policy.] [The company has a right to

increase premiums on this policy form in the future, provided it raises rates for all

policies in the same class in this state.] [Insurers shall use appropriate bracketed

statement. Rate guarantees shall not be shown on this form.]



Rate Increase History

The company has sold long-term care insurance since [year] and has sold this

policy since [year]. [The company has never raised its rates for any long-term care

policy it has sold in this state or any other state.] [The company has not raised its

rates for this policy form or similar policy forms in this state or any other state in

the last 10 years.] [The company has raised its premium rates on this policy form

or similar policy forms in the last 10 years. Following is a summary of the rate

increases.]

Drafting Note: A company may use the first bracketed sentence above only if it has never

increased rates under any prior policy forms in this state or any other state. The issuer

shall list each premium increase it has instituted on this or similar policy forms in this

state or any other state during the last 10 years. The list shall provide the policy form,

the calendar years the form was available for sale, and the calendar year and the amount

(percentage) of each increase. The insurer shall provide minimum and maximum

percentages if the rate increase is variable by rating characteristics. The insurer may

provide, in a fair manner, additional explanatory information as appropriate.

Questions Related to Your Income

How will you pay each year’s premium?

From my Income

From my Savings/Investments

My Family will Pay

Have you considered whether you could afford to keep this policy if the

premiums went up, for example, by 20%?

Drafting Note: The issuer is not required to use the bracketed sentence if the policy is

fully paid up or is a noncancellable policy.

What is your annual income? (check one)

Under $10,000

$[10-20,000]

$[20-30,000]

$[30-50,000]

Over $50,000

Drafting Note: The issuer may choose the numbers to put in the brackets to fit its

suitability standards.

How do you expect your income to change in the next 10 years? (check one)

No change

Increase

Decrease

If you will be paying premiums with money received only from your own

income, a rule of thumb is that you may not be able to afford this policy if the

premiums will be more than 7% of your income.

Will you buy inflation protection?

(check one)

Yes

If not, have you considered how you will pay for the difference between future

costs and your daily benefit amount?

Incomey mFrom

From my Savings/Investments

My Family will Pay

The national average annual cost of care in [insert year] was [insert $

amount], but this figure varies across the country. In ten years the national

average annual cost would be about [insert $ amount] if costs increase 5%

annually.

Drafting Note: The projected cost can be based on federal estimates in a current year.

In the above statement, the second figure equals 163% of the first figure.

What elimination period are you considering?

Number of days:

Approximate cost: $ for that period of care.

How are you planning to pay for your care during the elimination period?

(check one)

From my Income

From my Savings/Investments

My Family will Pay

Questions Related to Your Savings and Investments

Not counting your home, about how much are all of your assets (your

savings and investments) worth? (check one)

Under $20,000

$20,000-$30,000

$30,000-$50,000

Over $50,000

How do you expect your assets to change over the next ten years? (check

one)

Stay about the same

Increase

Decrease

If you are buying this policy to protect your assets and your assets are less

than $30,000, you may wish to consider other options for financing your long-

term care.

__________________________

_________________________________________

____________________

__________________

Disclosure Statement

The answers to the questions above describe my financial situation

– Or –

I choose not to complete this information.

(Check one)

I acknowledge that the carrier and/or its agent (below) has reviewed this form with

me including the premium, premium rate increase history and potential for

premium increases in the future. [For direct mail situations, use the following: I

acknowledge that I have reviewed this form including the premium, premium rate

increase history and potential for premium increases in the future.] I understand

the above disclosures.

I understand that the rates for this policy may increase in the future.

(This box must be checked)

Applicant Signature: Date:

[I explained to the applicant the importance of completing this information

Agent Signature: Date:

Agent’s Printed Name: ]

[ In order for us to process your application, please return this signed statement to

[name of company], along with your application. ]

[ My agent has advised me that this policy does not seem to be suitable for me.

However, I still want the company to consider my application.

Applicant Signature: Date:

Drafting Note: Choose the appropriate sentences depending on whether this is a direct

mail or agent sale.

The company may contact you to verify your answers.

Drafting Note: When the Long-Term Care Insurance Personal Worksheet is furnished to

employees and their spouses under employer group policies, the text from the heading

“Disclosure Statement” to the end of the page may be removed.

 List of State Insurance Departments,

Agencies on Aging and State Health

Insurance Assistance Programs

List of State Insurance Departments, Agencies on Aging

and State Health Insurance Assistance Programs

Each state has its own laws and regulations governing all types of insurance. The

insurance departments, which are listed in the left column, are responsible for

enforcing these laws, as well as providing the public with information about

insurance. The agencies on aging, listed in the right column, are responsible for

coordinating services for older Americans. Centered below each state listing is the

telephone number for the insurance counseling programs. Please note that calls to

800 numbers listed here can only be made from within the respective state.

ALABAMA

Alabama Department of Insurance

201 Monroe Street, Suite 1700, Montgomery, AL 36104

(334) 269-3550 • Fax: (334) 241-4192 • www.aldoi.org

Alabama Department of Senior Services

P.O. Box 301851, 770 Washington Ave, Suite 470, Montgomery, AL 36130-1851

1-800-243-5463 • (334) 242-5743 • Fax: (334) 242-5788

Alabama State Health Insurance Assistance Programs

1-800-243-5463 • (334) 242-5743 • Fax: (334) 242-5594 • TDD: (334) 242-0995

ALASKA

Alaska Division of Insurance

P.O. Box 110805, 3601 C Street, Suite 1324, Anchorage, AK 99811-0805

(907) 269-7900 • Fax: (907) 269-7910 • www.commerce.state.ak.us/insurance

Alaska Commission on Aging, Dept. of Health and Social Services

P.O. Box 110693, Juneau, AK 99811-0693

(907) 465-4879 • Fax: (907) 465-4716

Alaska State Health Insurance Assistance Programs

1-800-478-6065 In State Only • (907) 269-3680 • Fax: (907) 269-3690 • TDD (907) 269-3691

AMERICAN SAMOA

Office of the Governor, American Samoa Government

Pago Pago, American Samoa 96799

011-684-633-4116 • Fax: 011-684-633-2269

Territorial Administration on Aging, American Samoa Government

Pago Pago, American Samoa 96799

011 (684) 633-1251-1252 • Fax: 011 (684) 633-2533

ARIZONA

Arizona Department of Insurance

910 North 44th Street, Suite 210, Phoe2 nix, AZ 85018-7269

(602) 364-3100 • Fax: (602) 364-3470 • www.id.state.az.us

Division of Aging and Adult Services

1789 W Jefferson - No. 950A, Phoenix, AZ 85007

(602) 542-4446 • Fax: (602) 542-6575

Arizona State Health Insurance Assistance Programs

1-800-432-4040 • TDD (602) 542-6366 • Fax: (602) 542-6575

ARKANSAS

Arkansas Department of Insurance

1200 West 3rd Street, Little Rock, AR 72201-1904

(501) 371-2600 • Fax: (501) 371-2618 • www.insurance.arkansas.gov

Division of Aging & Adult Services, Arkansas Dept of Human Services

P.O. Box 1437, S530, 700 Main Street, Little Rock, AR 72203-1437

(501) 682-2441 • Fax: (501) 682-8155

Arkansas State Health Insurance Assistance Programs

1-800-282-9134 • (501) 371-2600 • Fax (501) 371-2618 • TDD 501-371-2718 • 1-501-682-3000

CALIFORNIA

California Dept. of Insurance

300 Capitol Mall, Suite 1700, Sacramento, CA 95814

(916) 492-3500 • Fax: (916) 445-5280 • www.insurance.ca.gov

California Department of Aging

1300 National Drive, Suite 200 Sacramento, CA 95834

(916) 419-7500 • Fax: (916) 928-2500

California State Health Insurance Assistance Programs

1-800-434-0222 • (916) 323-6525 • Fax: (916) 327-2081

COLORADO

Colorado Division of Insurance

1560 Broadway, Suite 850, Denver, CO 80202

(303) 894-7499 • Fax: (303) 894-7455 • www.dora.state.co.us/insurance

Colorado Division of Aging and Adult Services, Department of Human Services

1575 Sherman Street, Tenth Floor, Denver, CO 80203-1714

(303) 866-2800 • Fax: (303) 866-2696

Colorado State Health Insurance Assistance Programs

1-800-544-9181 or 1-888-696-7213 • (303) 894-7553 • TDD (303) 894-7880 • (303) 894-7455

COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS

Mariana Islands CNMI Office on Aging, Commonwealth of the Northern Mariana Islands

P.O. Box 502178, Saipan, MP 96950-2178

011 (671) 734-4361 • Fax: 011 (670) 233-1327

CONNECTICUT

Connecticut Dept. of Insurance

P.O. Box 816, Hartford, CT 06142-0816

(860) 297-3800 • Fax: (860) 566-7410 • www.ct.gov/cid

Connecticut Aging Services Division, Department of Social Services

25 Sigourney St., Hartford, CT 06106

(860) 424-5277 • Fax: (860) 424-4886

Connecticut State Health Insurance Assistance Programs

(860) 424-5862 • In State Only • 1-800-994-9422 • TDD (860) 842-5424 • Fax: (860) 424-5301

DELAWARE

Delaware Dept. of Insurance

Rodney Building, 841 Silver Lake Boulevard, Dover, DE 19904

(302) 674-7300 • Fax: (302) 739-6278 • www.delawareinsurance.gov

Div. of Services for Aging & Adults w/ Physical Disabilities, Dept. of Health & Social Services

1901 North DuPont Highway, New Castle, DE 19720

(302) 255-9390 • Fax: (302) 255-4445

Delaware State Health Insurance Assistance Programs

1-800-336-9500 • (302) 674-7364 • Fax: (302) 739-5280

DISTRICT OF COLUMBIA

Dept. of Insurance, Securities & Banking, Government of the District of Columbia

810 First Street, N.E., Suite 701 Washington, DC 20001

(202) 727-8000 x3018 • Fax: (202) 535-1196 • http://disb.dc.gov

District of Columbia Office on Aging

One Judiciary Square, 441 4th St., N.W., 9th Floor, Washington, DC 20001

(202) 724-5622 • Fax: (202) 724-4979

District of Columbia Health Insurance Assistance Programs

(202) 739-0668 • Fax: (202) 293-4043

FEDERATED STATES OF MICRONESIA

State Agency on Aging, Office of Health Services, Federated States of Micronesia

Ponape, E.C.I. 96941

FLORIDA

Florida Department of Insurance

200 East Gaines Street, Tallahassee, FL 32399-0300

(850) 413-2804 • Fax: (850) 413-2950 • www.floir.com

Florida Department of Elder Affairs

Building B - Suite 152, 4040 Esplanade Way, Tallahassee, FL 32399

(850) 414-2000 • Fax: (850) 414-2004

Florida State Health Insurance Assistance Programs

1-800-963-5337 • (850) 414-2000 • TDD (850) 414-2001 • Fax: (850) 414-2004

GEORGIA

Georgia Department of Insurance

2 Martin Luther King, Jr. Drive, Floyd Memorial Bldg., 704 West Tower, Atlanta, GA 30334

(404) 656-2056 • Fax: (404) 657-8542 • www.gainsurance.org

Georgia Division for Aging Services

2 Peachtree St. N.W. 9th Floor, Atlanta, GA 30303

(404) 657-5258 • Fax: (404) 657-5285

Georgia State Health Insurance Assistance Programs

1-800-669-8387 • (404) 657-5347 • Fax: (404) 657-5285

GUAM

Dept. of Revenue and Taxation, Banking Insurance Commissioner

PO Box 23607, GMF, Barrigada, Guam 96921 (1240 Route 16, Barrigada, Guam, 96913)

(671) 475-1843 through -1846 • Fax: (671) 633-2643 • www.guamtax.com

Regulatory Programs Administrator, Dept. of Revenue and Taxation

P.O. Box 23607 GMF, Barrigada, Guam 96921 1240 Route 16, Barrigada, Guam 96913

(use street address only if using US Express Mail, DHL, FedEx or UPS)

Email: [email protected].gu • (671) 635-1846

HAWAII

Hawaii Insurance Division

PO Box 3614, 335 Merchant Street, Room 2113, Honolulu, HI 96811

(808) 586-2790 • Fax: (808) 587-6714 • www.hawaii.gov/dcca/ins

Hawaii Executive Office on Aging

No. 1 Capitol District, 250 South Hotel St., Ste 406, Honolulu, HI 96813-2831

(808) 586-0100 • Fax: (808) 586-0185

Hawaii State Health Insurance Assistance Programs

1-888-875-9229 • (808) 586-7300 • Fax: (808) 586-0185

IDAHO

Idaho Department of Insurance

700 West State Street, 3rd Floor, Boise, ID 83720-0043

(208) 334-4250 • Fax: (208) 334-4398 • www.doi.idaho.go

Idaho Commission on Aging

3380 Americana Terrace, Suite 120, P.O. Box 83720, Boise, ID 83720-0007

(208) 334-3833 • Fax: (208) 334-3033

Idaho State Health Insurance Assistance Programs

1-800-247-4422 • (208) 334-4350 • TDD 1-800-377-3529 • Fax: (208) 334-4389

ILLINOIS

Illinois Division of Insurance

320 West Washington St., 4th Floor, Springfield, IL 62767-0001

(217) 782-4515 • Fax: (217) 782-5020• www.idfpr.com/DOI/default2.asp

Illinois Department on Aging

421 East Capitol Ave., Suite 100, Springfield, IL 62701-1789

(217) 785-3356 • Fax: (217) 785-4477

Illinois State Health Insurance Assistance Programs

1-800-548-9034 • (217) 782-0004 • TDD (217) 524-4872 In State Only • Fax: (217) 782-4105

INDIANA

Indiana Department of Insurance

311 W. Washington St., Suite 300 Indianapolis, IN 46204-2787

(317) 232-2385 • Fax: (317) 232-5251 www.in.gov/idoi

Family and Services Administration, Division of Aging

402 W. Washington St., P.O. Box 7083, Indianapolis, IN 46207-7083

(317) 232-7123 • Fax: (317) 232-7867

Indiana State Health Insurance Assistance Programs

1-800-452-4800 In State Only • (765) 608-2318 • Fax: (765) 608-2322

IOWA

Division of Insurance, State of Iowa

330 E. Maple Street, Des Moines, IA 50319

(515) 281-5705 • Fax: (515) 281-3059 • www.iid.state.ia.us

Iowa Department of Elder Affairs

Jessie M. Parker Bldg., 510 East 12th St., Suite 2, Des Moines, IA 50319-9025

(515) 242-3333 • Fax: (515) 725-3300

Iowa State Health Insurance Assistance Programs

1-800-351-4664 In State Only • TTY 1-800-735-2942 • (515) 281-6867 • Fax: (515) 281-3059

KANSAS

Kansas Department of Insurance

420 S.W. 9th Street, Topeka, KS 66612-1678

(785) 296-3071 • Fax: (785) 296-7805 • www.ksinsurance.org

Kansas Department on Aging

New England Building, 503 South Kansas Avenue, Topeka, KS 66603-3404

(785) 296-4986 • 1-800 432-3535 • Fax: (785) 296-0256

Kansas State Health Insurance Assistance Programs

1-800-860-5260 • (316) 337-7386 • TDD 1-877-235-3151 • Fax: (316) 337-6018

KENTUCKY

Kentucky Dept. of Insurance

P.O. Box 517, 215 West Main Street, Frankfort, KY 40602-0517

(502) 564-6027 • Fax: (502) 564-1453 • www.doi.state.ky.us/kentucky

Kentucky Office of Aging Services, Cabinet for Health Services

275 East Main Street, 3W-F, Frankfort, KY 40621

(502) 564-6930 • Fax: (502) 564-4595

Kentucky State Health Insurance Assistance Programs

1-877-293-7447 • (502) 564-7372 • TTY 1-888-642-1137 • Fax: (502) 564-4595

LOUISIANA

Louisiana Dept.of Insurance

1702 N. 3rd Street, Baton Rouge, LA 70802

(225) 342-5423 • Fax: (225) 342-8622 • www.ldi.la.gov

Governor’s Office of Elderly Affairs

PO Box 61, 412 N 4th St., Baton Rouge, LA 70821

(225) 342-7100 • Fax: (225) 342-7133

LOUISIANA State Health Insurance Assistance Programs

Both In State Only 1-800-259-5301 • (225) 342-5301 • Fax: (225) 342-7401

MAINE

Maine Bureau of Insurance, Dept. of Professional & Financial Reg.

State Office Building, Station 34 Augusta, ME 04333-0034

(207) 624-8475 • Fax: (207) 624-8599 • www.maine.gov/insurance

Maine Bureau of Elder & Adult Services

442 Civic Center Drive, 11 State House Station, Augusta, ME 04333-001

(207) 287-9200 • Fax: (207) 287-9229

Maine State Health Insurance Assistance Programs

In State Only 1-877-353-3771 • Fax: (207) 624-5361

MARYLAND

Maryland Insurance Administration

525 St. Paul Place, Baltimore, MD 21202-2272

(410) 468-2090 • Fax: (410) 468-2020 • www.mdinsurance.state.md.us

Maryland Department of Aging

State Office Building, Room 1007, 301 West Preston Street, Baltimore, MD 21201

(410) 767-1100 • Fax: (410) 333-7943

Maryland State Health Insurance Assistance Programs

Both In State Only 1-800-243-3425 • (410) 767-1109 • Fax: (410) 333-7943

MASSACHUSETTS

Division of Insurance, Commonwealth of Massachusetts

One South Station, 5th Floor, Boston, MA 02110

(617) 521-7794 • Fax: (617) 521-7575 • www.mass.gov/doi

Massachusetts Executive Office of Elder Affairs

One Ashburton Place, 5th Floor, Boston, MA 02108

(617) 727-7750 • Fax: (617) 727-9368

Massachusetts State Health Insurance Assistance Programs

1-800-AGE-INFO • (617) 727-7750 • Fax: (617) 727-9368

MICHIGAN

Office of Financial and Insurance Services, State of Michigan

611 W. Ottawa St., 3rd Floor North, Lansing, MI 48933-1020

(517) 335-3167 • Fax: (517) 335-4978 • www.michigan.gov/ofis

Michigan Office of Services to the Aging

P.O. Box 30676, 7109 W. Saginaw, First Floor, Lansing, MI 48909

(517) 373-8230 • Fax: (517) 373-4092 • (FedEx Zip: 48917)

Michigan State Health Insurance Assistance Programs

1-800-803-7174 • (517) 886-0899 • Fax: (517) 886-1305

MINNESOTA

Minnesota Dept. of Commerce

85 7th Place East, Suite 500, St. Paul, MN 55101-2198

(651) 296-6025 • Fax: (651) 282-2568 • www.commerce.state.mn.us

Minnesota Board on Aging, Aging and Adult Services Division

540 Cedar Street, St. Paul, MN 55101

(651) 431-2600 • Fax: (651) 297-7855

Minnesota State Health Insurance Assistance Programs

1-800-333-2433 • Fax: (651) 641-8614

MISSISSIPPI

Mississippi Insurance Dept.

501 N. West Street, Woolfolk State Office Bldg., 10th Fl., Jackson, MS 39201

(601) 359-3569 • Fax: (601) 359-1077 • www.doi.state.ms.us

Mississippi Council on Aging, Division of Aging & Adult Services

750 N. State Street, Jackson, MS 39202

(601) 359-4925 • Fax: (601) 359-4370

Mississippi State Health Insurance Assistance Programs

In State Only 1-800-948-3090 • (601) 359-4929 • Fax: (601) 359-9664

MISSOURI

Missouri Department of Insurance

301 West High Street, Suite 530, Jefferson City, MO 65101

(573) 751-4126 • Fax: (573) 751-1165 • www.insurance.mo.gov

Missouri Department of Health and Senior Services, Division of Senior Services and Regulations

3425 Constitution Court Suite E, Jefferson City, MO 65109-0570

(573) 817-8300 • Fax: (573) 522-1473

Missouri State Health Insurance Assistance Programs

(573) 817-8300 • In State Only 1-800-390-3330 •Fax: (573) 817-8341

MONTANA

Montana Department of Insurance

840 Helena Avenue Helena, MT 59601

(406) 444-2040 • Fax: (406) 444-3497 • www.sao.mt.gov

Montana Office on Aging, Senior Long Term Care Division, Department of Public Health and

Human Services

111 Sanders Street, P.O. Box 4210, Helena, MT 59604

(406) 444-7788 • Fax: (406) 444-7743

Montana State Health Insurance Assistance Programs

1-800-551-3191 • In State Only 1-800-332-2272 • Fax: (406) 444-7743

NEBRASKA

Nebraska Department of Insurance

Terminal Building, Suite 400, 941 ‘O’ Street, Lincoln, NE 68508

(402) 471-2201 • Fax: (402) 471-4610 • www.doi.ne.gov

Nebraska Division of Aging and, Disability Services

P.O. Box 95026, 301 Centennial Mall-South, Lincoln, NE 68509

(402) 471-2307 • Fax: (402) 471-4619

Nebraska State Health Insurance Assistance Programs

(402) 471-4506 • In State Only 1-800-234-7119 or 1-800-833-7352 • Fax: (402) 471-6559

NEVADA

Nevada Division of Insurance

788 Fairview Drive, Suite 300, Carson City, NV 89701-5753

(775) 687-4270 • Fax: (775) 687-3937 • www.doi.state.nv.us

Nevada Division For Aging Services, Department of Human Resources

3416 Goni Road, Building D-132, Carson City, NV 89706

(775) 687-4210 • Fax: (775) 687-4264

Nevada State Health Insurance Assistance Programs

1-800-307-4444 • (702) 486-3478 • Fax: (702) 486-0865

NEW HAMPSHIRE

New Hampshire Department of Insurance

21 South Fruit Street, Suite 14, Concord, NH 03301

(603) 271-2261 • Fax: (603) 271-1406 • www.nh.gov/insurance

New Hampshire Division of Elderly & Adult Services

State Office Park South, Brown Building - 129 Pleasant St., Concord, NH 03301-3857

(603) 271-4394 • Fax: (603) 271-4643

New Hampshire State Health Insurance Assistance Programs

1-800-852-3388 In State Only • (603) 271-3944 • Fax: (603) 271-4643

NEW JERSEY

New Jersey Dept. of Insurance

20 West State Street CN325, Trenton, NJ 08625

(609) 292-5360 • Fax: (609) 984-5273 • www.njdobi.org

New Jersey Aging & Community Services, Dept. of Health and Senior Services

P.O. Box 807, Trenton, NJ 08625-0807

(609) 943-3345 • Fax: (609) 943-3343

New Jersey State Health Insurance Assistance Programs

1-800-792-8820 • Fax: (609) 943-4033

NEW MEXICO

New Mexico Dept. of Insurance

P.O. Drawer 1269, Santa Fe, NM 87504-1269

(505) 827-4601 • Fax: (505) 476-0326 • www.nmprc.state.nm.us/id.htm

New Mexico Aging & LTC Services Department

2550 Cerrillos Road, Santa Fe, NM 87505

(505) 476-4799 • Fax: (505) 476-4836

New Mexico State Health Insurance Assistance Programs

(505) 827-7640 In State Only • 1-800-432-2080 • Fax: (505) 476-4836

NEW YORK

New York Dept. of Insurance

25 Beaver Street, New York, NY 10004-2319

(212) 480-2292 • Fax: (212) 480-2310 • www.ins.state.ny.us

New York Office for the Aging

Two Empire State Plaza, Albany, NY 12223-1251

(518) 474-7012 • Fax: (518) 474-1398

New York State Health Insurance Assistance Programs

1-800-333-4114 • Fax: (518) 486-2225

NORTH CAROLINA

North Carolina Dept. of Insurance

1201 Mail Service Center, Raleigh, NC 27699-1201

(919) 733-3058 • Fax: (919) 733-6495 • www.ncdoi.com

North Carolina Division of Aging

2101 Mail Service Center, Raleigh, NC 27699

(919) 733-3983 • Fax: (919) 733-0433

Office Address (FedEx): 693 Palmer Drive, Raleigh, NC 27699-2101

North Carolina State Health Insurance Assistance Programs

1-800-443-9354 • Fax: (919) 733-3682

NORTH DAKOTA

North Dakota Dept. of Insurance

600 E. Boulevard, Bismarck, ND 58505-0320

(701) 328-2440 • Fax: (701) 328-4880 • www.nd.gov/ndins

North Dakota Aging Services Division, Department of Human Services

1237 West Divide Ave, Suite 6, Bismarck, ND 58501-0208

(701) 328-4601 • Fax: (701) 328-8744

North Dakota State Health Insurance Assistance Programs

1-800-247-0560 • TDD 1-800-366-6888 • Fax: (701) 328-4880

OHIO

Ohio Department of Insurance

2100 Stella Court, Columbus, OH 43215-1067

(614) 644-2658 • Fax: (614) 644-3743 • www.ohioinsurance.gov

Ohio Department of Aging

50 West Broad Street, 9th Fl., Columbus, OH 43215-5928

(614) 466-5500 • Fax: (614) 995-1049

Ohio State Health Insurance Assistance Programs

1-800-686-1578 • (614) 644-3399 • TDD (614) 644-3745 • Fax: (614) 752-0740

OKLAHOMA

Oklahoma Dept. of Insurance

2401 NW 23rd St., Suite 28, Oklahoma City, OK 73107

(405) 521-2828 • Fax: (405) 521-6635 • www.oid.state.ok.us

Oklahoma Dept. of Human Services, Aging Services Division

P.O. Box 25352, 2401 N.W., 23rd St., Suite 40, Oklahoma City, OK 73107-2422

(405) 521-2327 • Fax: (405) 521-2086

Oklahoma State Health Insurance Assistance Programs

(405) 521-6628 In State Only • 1-800-763-2828 • Fax: (405) 522-4492

OREGON

Oregon Insurance Division

350 Winter Street NE, Room 440, Salem, OR 97301-3838

(503) 947-7980 • Fax: (503) 378-4351 • www.insurance.oregon.gov

Oregon Senior & Disabled Services Division

500 Summer St., N.E., E02, Salem, OR 97301-1073

(503) 945-5811 • Fax: (503) 373-7823

Oregon State Health Insurance Assistance Programs

(503) 947-7263 In State Only • 1-800-722-4134 • Fax: (503) 378-4351

PALAU

State Agency on Aging, Department of Social Services

Republic of Palau, P.O. Box 100, Koror, Palau 96940

PENNSYLVANIA

Pennsylvania Insurance Dept.

1326 Strawberry Square, 13th Floor, Harrisburg, PA 17120

(717) 783-0442 • Fax: (717) 772-1969 • www.ins.state.pa.us

Pennsylvania Department of Aging

555 Walnut Street, 5th Fl., Harrisburg, PA 17101-1919

(717) 783-1550 • Fax: (717) 772-3382

Pennsylvania State Health Insurance Assistance Programs

1-800-783-7067 • Must call SHIP number to obtain proper fax number depending on

location in state

PUERTO RICO

Puerto Rico Dept. of Insurance

B5 Calle Tabonuco Suite 216, PMB 356, Guaynabo, PR 00968-3029

(787) 722-8686 • Fax: (787) 273-6082 • www.ocs.gobierno.pr

Governors Office For Elderly Affairs

P.O. Box 191179, San Juan, PR 00919-1179

(787) 721-6121 • Fax: (787) 721-6510

Puerto Rico Health Insurance Assistance Programs

1-877-725-4300 • (787) 721-8590 • Fax: (787) 721-6510

REPUBLIC OF THE MARSHALL ISLANDS

State Agency on Aging, Department of Social Services, Republic of the Marshall Islands

Marjuro, Marshall Islands 96960

RHODE ISLAND

Rhode Island Insurance Division

233 Richmond Street, Suite 233, Providence, RI 02903-4233

(401) 222-2223 • Fax: (401) 222-5475 • www.dbr.state.ri.us

Department of Elderly Affairs

35 Howard Avenue, Benjamin Rush Bldg 55, Cranston, RI 02920

(401) 462-3000 • Fax: (401) 462-0503

Rhode Island State Health Insurance Assistance Programs

(401) 222-2130

SOUTH CAROLINA

South Carolina Dept. of Insurance

Capitol Center, 1201 Maine Street, Suite 1000, Columbia, SC 29201

(803) 737-6160 • Fax: (803 ) 737-6229 • http://www.doi.sc.gov

Dept. of Health & Human Services, Bureau of Senior Services

P.O. Box 8206, 1801 Main St., Columbia, SC 29202-8206

(803) 734-9900 • Fax: (803) 898-4515

South Carolina State Health Insurance Assistance Programs

1-800-868-9095 • (803) 898-2850 • Fax: (803) 734-9886

SOUTH DAKOTA

South Dakota Division of Insurance Dept. of Commerce & Regulation

445 East Capitol Avenue, 1st Floor Pierre, SD 57501-3185

(605) 773-3563 • Fax: (605) 773-5369 www.state.sd.us/insurance

South Dakota Office of Adult Services & Aging, Department of Social Services

700 Governors Drive, Pierre, SD 57501

(605) 773-3656 • Fax: (605) 773-6834

South Dakota State Health Insurance Assistance Programs

1-800-536-8197 • (605) 773-3656 • TDD 1-800-642-6410 • Fax: (605) 336-7471

TENNESSEE

Tennessee Dept. of Commerce & Ins.

Davy Crockett Tower, Fifth Floor, 500 James Robertson Parkway, Nashville, TN 37243-0565

(615) 741-2241 • Fax: (615) 532-6934 • www.state.tn.us/commerce

Tennessee Commission on Aging and Disability

Andrew Jackson Building, 500 Deaderick Street, No. 825, Nashville, TN 37243-0860

(615) 741-2056 • Fax: (615) 741-3309

Tennessee State Health Insurance Assistance Programs

1-877-801-0044 • (615) 242-0438 • TDD (615) 532-3893 • Fax: (731) 587-6744

TEXAS

Texas Department of Insurance

333 Guadalupe Street, Austin, TX 78701

1-800-252-3439 Consumer Help Line • (512) 463-6464 • Fax: (512) 475-2005 •

www.tdi.state.tx.us

Texas Department of Aging & Disability Services

P.O. Box 149030 (W-619), Austin, TX 78714-9030

1-800-252-9240 • (512) 438-3030 • Fax: (512) 438-4220

Texas State Health Insurance Assistance Programs

1-800-252-9240 • TDD 1-800-735-2989 • Fax: (512) 305-7463

UTAH

Utah Department of Insurance

3110 State Office Building, Salt Lake City, UT 84114-1201

(801) 538-3800 • Fax: (801) 538-3829 • www.insurance.utah.gov

Utah Division of Aging & Adult Services, Department of Human Services

120 North 200 West, Room 325, Salt Lake City, UT 84103

(801) 538-3910 • Fax: (801) 538-4395

Utah State Health Insurance Assistance Programs

1-800-541-7735 • (801) 538-3910 • Fax: (801) 538-4395

SOUTH DAKOTA

South Dakota Division of Insurance Dept. of Commerce & Regulation

445 East Capitol Avenue, 1st Floor Pierre, SD 57501-3185

(605) 773-3563 • Fax: (605) 773-5369 www.state.sd.us/insurance

South Dakota Office of Adult Services & Aging, Department of Social Services

700 Governors Drive, Pierre, SD 57501

(605) 773-3656 • Fax: (605) 773-6834

South Dakota State Health Insurance Assistance Programs

1-800-536-8197 • (605) 773-3656 • TDD 1-800-642-6410 • Fax: (605) 336-7471

TENNESSEE

Tennessee Dept. of Commerce & Ins.

Davy Crockett Tower, Fifth Floor, 500 James Robertson Parkway, Nashville, TN 37243-0565

(615) 741-2241 • Fax: (615) 532-6934 • www.state.tn.us/commerce

Tennessee Commission on Aging and Disability

Andrew Jackson Building, 500 Deaderick Street, No. 825, Nashville, TN 37243-0860

(615) 741-2056 • Fax: (615) 741-3309

Tennessee State Health Insurance Assistance Programs

1-877-801-0044 • (615) 242-0438 • TDD (615) 532-3893 • Fax: (731) 587-6744

TEXAS

Texas Department of Insurance

333 Guadalupe Street, Austin, TX 78701

1-800-252-3439 Consumer Help Line • (512) 463-6464 • Fax: (512) 475-2005 •

www.tdi.state.tx.us

Texas Department of Aging & Disability Services

P.O. Box 149030 (W-619), Austin, TX 78714-9030

1-800-252-9240 • (512) 438-3030 • Fax: (512) 438-4220

Texas State Health Insurance Assistance Programs

1-800-252-9240 • TDD 1-800-735-2989 • Fax: (512) 305-7463

UTAH

Utah Department of Insurance

3110 State Office Building, Salt Lake City, UT 84114-1201

(801) 538-3800 • Fax: (801) 538-3829 • www.insurance.utah.gov

Utah Division of Aging & Adult Services, Department of Human Services

120 North 200 West, Room 325, Salt Lake City, UT 84103

(801) 538-3910 • Fax: (801) 538-4395

Utah State Health Insurance Assistance Programs

1-800-541-7735 • (801) 538-3910 • Fax: (801) 538-4395

WEST VIRGINIA

West Virginia Dept. of Insurance

P.O. Box 50540, Charleston, WV 25305-0540

(304) 558-3354 • Fax: (304) 558-0412 • www.wvinsurance.gov

West Virginia Bureau of Senior Services

1900 Kanawha Blvd, East, State Capitol, Charleston, WV 25305-0160

(304) 558-3317 • Fax: (304) 558-5609

West Virginia State Health Insurance Assistance Programs

1-877-987-4463 • (304) 558-3317 • Fax: (304) 558-5609

WISCONSIN

Office of the Commissioner of Ins., State of Wisconsin

PO Box 7873, 125 South Webster Street, GEF III – 2nd floor, Madison, WI 53707-7873

(608) 267-1233 • Fax: (608) 261-8579 • www.oci.wi.gov

Wisconsin Bureau of Aging & LTC Resources, Dept. of Health and Family Services

PO Box 7851, One West Wilson St., Room 450, Madison, WI 53707-7851

(608) 266-2536 • Fax: (608) 267-3203

Wisconsin State Health Insurance Assistance Programs

1-800-242-1060

WYOMING

Wyoming Department of Insurance

106 East 6th Avenue, Cheyenne, WY 82002-0440

(307) 777-7401 • Fax: (307) 777-5895 • http://insurance.state.wy.us

Wyoming Aging Division, Department of Health

6101 Yellow Stone Road, Room 259B, Cheyenne, WY 82002

(307) 777-7986 or 1-800-442-2766 • Fax: (307) 777-5340

Wyoming State Health Insurance Assistance Programs

1-800-856-4398 • (307) 856-6880 • Fax :(307) 856-4466

Formed in 1871, the National Association of Insurance

Commissioners (NAIC) is a voluntary organization of the chief

insurance regulatory officials of the 50 states, the District of

Columbia and five U.S. territories. The NAIC has three offices:

Executive Office, Washington, D.C.; Central Office, Kansas City, Mo.;

and Securities Valuation Office, New York City.

The NAIC serves the needs of consumers and the industry, with an

overriding objective of supporting state insurance regulators as

they protect consumers and maintain the financial stability of the

insurance marketplace.

For more information, visit www.naic.org.

12/2010