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Elimination For A Long Period Insurance

benefit eligible

The waiting period or the number of days during which you are deemed “benefit eligible” and normally getting care, but before you begin to receive reimbursement for services, is known as an elimination period (EP) in a long-term care insurance policy. It functions exactly like an elimination period, similar to your auto insurance deductible, except that the duration is expressed in hours rather than dollars.

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Before receiving benefits, you must pay for your long-term care (LTC) expenses out of pocket during this time. Your EP is established when you buy your coverage. This waiting time ranged from 0 to 365 days. Although some carriers have a zero-day EP for home care and a 90-day EP for institutional care, the 90-day EP is the most typical.

What Is Meant By “Benefit Eligible”?

 Benefits will only be paid out by particular “benefit triggers” for tax-qualified insurance sold after 1997. Benefit eligibility can occur in one of two ways under a tax-qualified policy:

Physical Impairment:

If at least 2 of the 6 activities of daily life (getting dressed, eating, using the restroom, and maintaining continence) require substantial assistance, OR

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Cognitive Impairment:

If you have a decline in the mental capacity that necessitates close supervision to safeguard your health and the health and safety of others, you are said to have a cognitive impairment. As an example of a cognitive disability, consider Alzheimer’s disease.

Are There Any Variations In Elimination Periods?

An insurance provider may alternatively count the EP in one of two other ways: “service days with credit” and “0-day EP for home care.”

Credit for Service Days:

It is necessary to get professional LTC services as per a standard service day EP in order to qualify for the “service days with credit.” But even if you only need one day of care, you will still receive a full week’s worth of credit.

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Day Zero for Home Care:

The phrase “0-day for home care” merely denotes the absence of a waiting period. If you are eligible for benefits, you can start receiving them right away.

As soon as you become benefit-eligible, submit your application so that the EP clock can begin. A shorter elimination period will typically have a higher premium. And a longer elimination period will typically have a lower premium if you can customize your EP. Consider what you can afford to pay for at that period with your own money. You can’t always alter the EP with policies. A 90-day elimination period is the most typical option.