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To search this Glossary, press Ctrl & F and type the word you wish to find into the box.
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Accelerated Death Benefit
A feature of a life insurance policy that lets you use some of the policy's death benefit prior to death.
Accessibility
As required by the Americans with Disabilities Act, removal of barriers that would hinder a person with a disability from entering, functioning, and working within a facility. Required restructuring of the facility cannot cause undue hardship for the employer.
ACF
See Alternate Care Facility.
Activities of Daily Living (ADLs)
Most policies use the inability to do a certain number of ADLs (such as 2 of 6) to decide when to pay benefits. Everyday functions and activities individuals usually do without help such as:
- Transferring which shall mean the ability to move into or out of bed, a chair or wheelchair.
- Continence which shall mean the ability to maintain bowel and bladder function; or when unable to maintain bowel or bladder function, the ability to perform associated personal hygiene (including caring for a catheter or colostomy bag).
- Toileting which shall mean getting to and from the toilet, getting on or off the toilet, and performing associated personal hygiene.
- Bathing which shall mean washing oneself by sponge bath or in either a tub or shower, including the act of getting into or out of a tub or shower.
- Dressing which shall mean putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.
- Eating which shall mean feeding oneself by getting food in the body from a receptacle (such as a plate, cup or table) or by feeding tube or intravenously.
Acute
Refers to a medical condition that is sudden in its onset and short in its duration. The opposite of a chronic condition.
Acute Care Services
Doctor visits and hospital episodes. Doctor visits include all medically related contacts with a physician, nurse, or other person acting under a physician's supervision. These contacts may be in person or by telephone. Hospital episodes include any continuous inpatient stay of one night or longer.
ADLs
See Activities of Daily Living.
Adult Day Care Facilities
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.
Adult Family Home
A private family home that provides residential care services and supervision for up to four adults. May also be referred to as a Residential Care Facility.
Age of Entry
The age of an insured person at the time of application or the effective date of an insurance plan. Initial permium and any premium increases are normally based on the age of entry.
Alternate Care Facility (ACF)
Is a place that provides 24-hour-a-day personal care or custodial care to those who suffer from activities of daily living. limitations or cognitive impairment, but who do not need professional nursing or therapy services (such as those offered in skilled nursing facilities and intermediate care facilities). This type of facility may be known as an Assisted Living Facility or a Custodial or Congregate Care Facility.
Alzheimer's Center
A community-based, long-term care program that provides day care for people in the moderate to severe stages of Alzheimer's disease or other related dementias, and provides various resource services for family caregivers and the community at large. Alzheimer's center identify the psychological and social needds of individuals and assist them in functioning at the highest level possible within individual degrees of mental and physical functioning. Also known as an Alzheimer's Day Care Resource Center.
Alzheimer's Disease (Click here for more information)
A progressive, degenerative form of dementia that causes severe intellectual deterioration.
Area Agency on Aging (AAA) (Click here for a local agency)
A local (city or county) agency, funded under the federal Older Americans Act, that plans and coordinates various social and health service programs for persons 60 years of age or more. The network of AAA offices consists of more than 600 approved agencies.
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.
Assistive Devices
Tools that enable individuals with disabilities to perform essential job functions, e.g., telephone headsets, adapted computer keyboards, enhanced computer monitors.
Automatic Increase Benefit
Automatic Increase Benefit (sometimes known as Cost of Living Adjustment Rider (COLA)) increases your Long Term Care benefits by 5% compounded each year (or 5% simple). This is typically selected if you are under age 70.
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Bathing
Washing oneself by sponge bath or in either a tub or shower, including the act of getting into or out of a tub or shower.
Bed Reservation Benefit
If an insured is receiving benefits during confinement to a nursing facility or residential care facility, we will continue to pay up to the maximum facility care daily benefit amount if the insured becomes hospitalized or temporarily leaves the facility and is billed by the facility to reserve existing accommodations. This benefit is payable for a maximum of 21 days per calendar year.
Benefit Triggers
Term used by insurance companies to describe the criteria and methods they use to determine when you are eligible to receive benefits. There is a limit to the amount or period of time an insurance coverage will pay for a particular service in a benefit period.
Benefit Amount/Limits
Monetary sum paid or payable to a recipient for which the insurance company has received the premiums.
Benefit Period
The length of time your insurance will last if you receive care every day at a cost equal to or more than your daily maximum benefit amount. If your care costs less, your insurance will last longer than the benefit period. The benefit period is used together with your daily maximum benefit amount calculate your lifetime maximum benefit.
Benefit Cap
The lifetime dollar limitation of a long-term care policy.
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Care Coordination Services
Services such as information, advice, and arranging of long-term care by a professional care coordinator.
Caregiver
A non-specific term describing either a skilled or nonskilled person who provides some type of care for another. In long-term care policies, types of care and types of caregivers are generally defined for purposes of identifying covered services.
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).
CCRC
See Continuing Care Retirement Communities.
Center for Medicare and Medicaid (CMS)
Formerly the U.S. Health Care Financing Administration, CMS is an element of the Department of Health and Human Services, which finances and administers the Medicare and Medicaid programs. Among other responsibilities, CMS establishes standards for the operation of nursing facilities that receive funds under the Medicare or Medicaid programs.
Chronic Care
Care provided to help maintain daily function. There is no expectation that the care recipient will improve or recover. Long-term care is chronic care.
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 descirbe a person who needs long term care either because of an inability to do everyday activities of daily living without help or because of a severe cognitive impairment.
COBRA - Consolidated Omnibus Budget Reconciliation Act (Click here for more information)
COBRA contains provisions giving certain former employees, retirees, spouses and dependent children the right to temporary continuation of health coverage at group rates.
Cognition
The process of knowing; of being aware of thoughts. The ability to reason and understand.
Cognitive Impairment (Click here for more information)
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.
COLA
See Cost of Living Adjustment Rider.
Community-Based Services
Services designed to help older people stay independent and in their own homes.
Conservator
Person appointed by the court to act as the legal representative of a person who is mentally or physically incapable of managing his or her affairs.
Continence
The ability to maintain bowel and bladder function; or when unable to maintain bowel or bladder function, the ability to perform associated personal hygiene (including caring for a catheter or colostomy bag).
Continuing Care Retirement Communities (CCRC)
A Retirement complex that offers a broad range of services and level of care.
Continuous Payment Option
A premium payment 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 but only on an entire class of policies, not just on your policy.
Cost of Living Adjustment Rider (COLA)
Cost of Living Adjustment Rider (COLA) increases your Long Term Care benefits by 5% compounded each year (or 5% simple). This is typically selected if you are under age 65.
Custodial Care (also called Personal Care)
Care to help individuals meet personal needs such as bathing, dressing, and eating. Someone without professional training may provide care.
CVA
Refers to a cerebrovascular accident or stroke in which an area of the brain is damaged due to a sudden interruption of blood supply.
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Daily Benefit
The amount of insurance benefit in dollars a person chooses to buy for long-term care expenses.
Death Benefit
In some long-term care policies, a benefit payable to the insured’s survivors or estate if the insured dies before a specified age. Often 65 or 70. The benefit amount is a refund of premiums the insured paid minus the amount of any benefits the insured received while living.
Deductible
The amount of health care expense that a Medicare beneficiary must first incur and pay out-of-pocket annually before Medicare will begin payment for covered services. Medicare deductibles include the Part A hospital deductible; the Part B deductible for all covered services under Part B; and the blood deductible.
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.
Durable Medical Equipment (DME)
Durable medical equipment, as defined by Medicare, is equipment which can 1) withstand repeated use, 2) is primarily and customarily used to serve a medical purpose, 3) generally not useful to a person in the absence of an illness or injury, and 4) is appropriate for use in the home (e.g. wheelchairs, hospital beds, walkers).
Durable Power of Attorney for Health Care (DPAHC)
A legal document in which a competent person gives another person (called an attorney-in-fact) the power to make health care decisions for him or her if unable to make those decisions. A DPA can include guidelines for the attorney-in-fact to follow in making decisions on behalf of the incompetent person.
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Eating
Feeding oneself by getting food in the body from a receptacle (such as a plate, cup or table) or by feeding tube or intravenously.
Edema
A collection of fluid in the tissues which causes swelling.
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 predium. Sometimes also called a "waiting period".
Emergency Medical Services (EMS)
Services utilized in responding to the perceived individual need for immediate treatment for medical, physiological, or psychological illness or injury.
Employee Retirement Income Security Act (ERISA)
A federal act, passed in 1974, that established new standards and reporting/disclosure requirements for employer-funded pension and health benefit programs.
End Stage Renal Disease (ESRD)
Medical condition in which a person's kidneys no longer function, requiring the individual to receive dialysis or a kidney transplant to sustain his or her life.
Exclusion/Exclusionary Rider
A condition not covered under the policy.See Waiver.
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 to 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.
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Fee-for-Service
The way traditional Medicare and health insurance work. Medical providers bill for whatever service they provide. Medicare and/or traditional insurance pay their share, and the patient pays the balance through co-payments and deductibles.
Fraud
The outright misrepresentation of facts with the direct intent to defraud either Medicare and/or an insurance company.
Free Look Period
The period of time, usually 30 days from the date of policy delivery, during which the policyholder may return the policy and receive a full refund.
Functional Disability
Physical dependence on others as a result of functional impairment.
Functional Disease
A disease associated with an upset in bodily function, rather than a change in structure of body cells.
Functional Disorder
A disorder caused by upset in function, not by organic disease process.
Functional Impairment, Physical
The inability to perform one or more Activities of Daily Living.
Functional Impairment, Mental
Cognitive impairment.
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Gatekeeper
A means of controlling access to services. Refers to policy provisions, restrictions or limitations that qualify the insured to begin receiving benefits, such as being referred for care by a physician, being unable to perform a specified number of activities of daily living, having a prior hospital confinement, or others. Technically, these are the coverage triggers in long-term care policies.
Geriatrician
Physician who is certified in the care of older people.
Geriatrics
The branch of medicine that focuses on providing health care for the elderly and the treatment of diseases associated with the aging process.
Gerontology
Study of the biological, psychological and social processes of aging.
Grace Period
Thirty days after the premium is due before the policy lapses.
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 premims (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.
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Hands-On Assistance
Physical assistance (minimal, moderate or maximal) without which the individual would not be able to perform the activity of daily living.
Health Care Financing Administration (HCFA)
The branch of the U.S. Department of Health and Human Services that administers the Medicare program.
Health Maintenance Organization (HMO)
Prepaid health plans which cover doctors' visits, hospital stays, emergency care, surgery, preventive care, checkups, lab tests, X-rays, and therapy. In a HMO, one must choose a primary care physician who coordinates all care and makes referrals to any specialists that may be required. In a HMO, one must use the doctors, hospitals and clinics that participate in your plan's network. No benefits are paid for non-emergency benefits provided outside the HMO network.
HIPAA - Health Insurance Portability and Accountability Act (Click here for more information)
Federal health insurance legislation passed in 1996 that allows, under specified conditions, long-term care policies to be qualified for certain tax benefits.
HMO
See Health Maintenance Organization.
Home Health Care
Services provided at home which may include nursing care; occupational, physical, respiratory or speech therapy; personal care; and homemaker services.
Home Health Care Agency
A public or privage agency that specializes in providing home health care. Also known as Home Health Agency (HHA).
Home Medical Equipment
See Durable Medical Equipment.
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
A program which provides palliative and supportive care for terminally ill patients and their families, either directly or on a consulting basis with the patient's physician or another community agency. The whole family is considered the unit of care, and care extends through their period of mourning.
Hospice Care
Continuous care provided at home or in a facility with a homelike setting for a terminally ill person. A terminally ill person has a life expectancy of six months or less.
Hospital Insurance (Part A)
That part (Part A) of the Medicare program which helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care.
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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
See Cost of Living Adjustment Rider (COLA).
Intermediate Care
Occasional nursing and rehabilitative care ordered by a doctor and performed or supervised by skilled medical personnel.
Intermediate Care Facility
A nursing facility licensed to provide intermediate care. It may also provide custodial care but not skilled nursing care. Intermediate care facilities normally provide basic room and board, supervision, limited nursing services, rehab services, and social activities, and are only required to have a registered nurse for one eight-hour shift.
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Lapse
Termination of a policy when a renewal premium is not paid.
Level of Care
In the context of long-term care, refers to the differences between:
- Skilled Nursing Care: 24 hour a day prescribed care provided by licensed medical professionals who are under the direct supervision of a physician.
- Intermediate Care: Prescribed care that can be provided on an intermittent, rather than continuous basis - for example, physical therapy.
- Custodial Care: Care that assists people with daily living requirements, such as dressing, eating and personal hygiene.
Life Care Community (LCC)
A continuing care retirement community.
Lifetime Maximum
The maximum total benefit that an insuance plan will ever pay. Not all plans have a lifetime maximum.
Lifetime Reserve
Under Medicare, 60 extra non-renewable days of hospitalization coverage available for use if a hospital stay exceeds the 90 days available in a benefit period. Once a reserve day is used, it is gone for life. Also called Reserve Days.
Limitation
A situation, circumstance, or condition under which an insurance policy will not pay. Limitations are listed in the exclusions in an insurance policy.
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 persons.
Living Will
A legal document in which a competent person directs in advance that artificial life-prolonging treatment not be used if he or she has or develops a terminal and irreversible condition and becomes incompetent to make health care decisions.
Long-Term Care
Long-Term Care is the kind of assistance you need when you need help with personal care. The need for this assistance usually results from a disabling or long-term medical or physical condition. Long-term care services can include home care, as well as nursing home or community-based care.
Long-Term Care Facility
See Nursing Home.
Long-Term Care Insurance
Insurance policies which pay for long-term care services (such as nursing home and home care) that Medicare and Medigap policies do not cover. Policies vary in terms of what they will cover, and may be expensive. Coverage may be denied based on health status or age.
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Maximum Benefit
A limit to the amount or period of time an insurance coverage will pay for a particular service in a benefit period. See Benefit Amount/Limits.
Means Test
Measure of income and assets to determine eligibility for government benefit programs such as Medicaid.
Medi-Cal (Medicaid in other states)
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. Medi-Cal is not health insurance, it is a welfare program funded by the taxpayers.
Medical Insurance (Part B)
That part (Part B) of the Medicare program that helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover (like some home health care). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.
Medical Supplies
Surgical dressings, splints, casts, and similar supplies, but not adhesive tape, antiseptics, or other common first-aid supplies.
Medically Necessity
Some policies also allow medical necessity as a qualifying criteria. This usually means that your doctor has certified that your medical condition will deteriorate if you do not receive needed services in a setting such as a nursing home or your own home.
Medicare
The federal program providing hospital and medical insurance to people aged 65 or older and to certail 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).
Medigap Insurance
See Medicare Supplement Insurance.
Mental Illness/Impairment
A deficiency in the ability to think, perceive, reason, or remember, resulting in loss of the ability to take care of one's daily living needs.
Morbidity
The extent of illness, injury, or disability in a defined population. It is usually expressed in general or specific rates of incidence or prevalence.
Mortality
Used to describe the relation of deaths to the population in which they occur.
Multi-Infarct Dementia
Mental impairment caused by a series of minor strokes that result in widespread death of brain tissue.
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Noncancelable Policies
Insurance contracts that cannot be cancelled by the insurance company and the rates cannot be changed by the insurance company.
Nurse Practitioner (R.N.,N.P.)
A registered nurse with training beyond basic nursing education who may perform physical examinations and diagnostic tests, counsel patients, and develop treatment programs.
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.
Nursing Home Insurance
Insurance that only covers, or primarily, care in a nursing home. The terms nursing home insurance and long-term care insurance are sometimes loosely used interchangeably.
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Occupational Therapist
Occupational therapists evaluate, treat, and consult with individuals whose abilities to cope with the tasks of everyday living are threatened or impaired by physical illness or injury, psychosocial disability, or developmental deficits. Occupational therapists work in hospitals, rehabilitation agencies, long-term-care facilities, and other health-care organizations.
Occupational Therapy
Medically directed therapy designed to assist patients who are impaired to function more independently. People who receive this type of therapy suffer from impaired perceptual ability or impaired ability to move or perform activities of daily living.
Option
Additional coverage or benefit that may be added at an additional cost to the basic insurance policy.
Orthopedics
A branch of medicine concerned with the corrective treatment of deformities, diseases, and ailments of bones, muscles, tendons, ligaments, joints, and cartilage.
Outpatient
A patient who is receiving ambulatory care at a hospital or other facility without being admitted to the facility. Usually, it does not mean people receiving services from a physician's office or other program which also does not provide inpatient care.
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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.
Palliative Care
Care directed towards relief of symptoms without attempting to be curative.
Parkinson’s Disease
An organic brain disease caused by degeneration of or damage to the basal nerve cells of the brain, usually in elderly people and characterized by tremors, muscle rigidity and a shuffling walk. About a third of diagnosed patients progress to dementia after ten or more years if untreated. Symptoms are less severe with drug treatment.
Part A
See Hospital Insurance.
Part B
See Medical Insurance.
Participating Provider
A hospital, skilled nursing facility, home health care agency, hospice, physician, or other health care supplier that meets certain standards and has a signed participation agreement with Medicare, MediCal (Medicaid), a PPO or other insurer. A participating provider agrees to accept payment from Medicare, MediCal (Medicaid), or a PPO as payment in full for covered care or services.
Partnership Policy
A type of policy that allows you to protect (keep) some of your assets if you apply for Medi-Cal after using your policy's benefits.
Peer Review
Generally, the evaluation by practicing physicians or other professionals of the effectiveness and efficiency of services ordered or performed by other members of the profession (peers).
Period of Care
Means a period of time, after the Wait Period, during which you are receiving Long-term Care due to (a) an inability to perform two or more activities of daily living; or (2) a Cognitive Impairment. A Period of Care begins on the first day you receive and are paid for Long-term Care through your Service Plan and ends when you are no longer receiving services or the period specified in your Service Plan has ended.
Period of Crisis
In Hospice Care, a period during which a patient requires continuous care, which is primarily nursing care, to achieve relief or management of acute medical symptoms.
Personal Care (also called Custodial Care)
Care to help individuals meet personal activities of daily living needs. Someone without professional training may provide care.
Personal Care Attendant
A certified or qualified aide affiliated with home health care agency whose responsibility is to provide assistance with health care, such as aid in performing activities of daily living.
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.
Physical Therapist
Someone with at least a bachelor's degree trained to perform physical therapy. A physical therapist reviews the physician's medical diagnosis and treatment plan, prepares a treatment schedule, and provides physical therapy until it is determined, that the physical therapy is no longer necessary or useful.
Physical Therapy
Services provided by specially trained and licensed physical therapists in order to relieve pain, restore maximum function, and prevent disability or injury.
Policy Summary
A summation of selected features of an insurance policy prepared and attached to the policy by the insurer for delivery to the policyowner/insured.
Pool of Money
See Maximum Lifetime Benefit.
Power of Attorney
A legal document allowing one person to act in a legal matter on another's behalf pursuant to financial or real-estate transactions.
Pre-Admission Screening
An assessment of a person's functional, social, medical, and nursing needs, to determine if the person should be admitted to nursing facility or other community-based care services available to eligible MediCal (Medicaid) recipients. Screenings are conducted by trained preadmission screening teams.
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.
Preferred Provider Organization (PPO)
A Health Care benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated Health Care providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by Health Care providers who are not part of the PPO network.
Prevailing Charge
An amount high enough to cover 75% of the customary charges made for medical supplies or services in the previous year, subject to an economic index limitation.
Primary Care Physician
Under a health maintenance organization (HMO) plan, the primary care physician is usually an insured person's first contact for health care. This is often a family physician, internist, or pediatrician. A primary care physician monitors patient health, treats most patient health problems, and refers patients, if necessary, to specialists. See primary care provider.
Prospective Payment System
Any method of paying hospitals or other health programs in which amounts or rates of payment are established in advance for a defined period (usually a year).
Prosthesis
An artificial substitute for a part of the body that is missing or has been removed surgically, for instance, a denture, an artificial limb, or a heart pacemaker.
Provider
See Participating Provider.
Psychotrophic Drugs
Antidepressants, anti-anxiety drugs, and anti-psychotic drugs used for delusions, extreme agitation, hallucinations, or paranoia. They are often referred to as mind or behavior altering drugs.
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Quality of Care
Can be defined as a measure of the degree to which delivered health services meet established professional standards and judgments of value to the consumer.
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Reasonable and Necessary
See Medically Necessity.
Reasonable Cost
The basis on which Medicare pays skilled nursing facilities and home health care agencies for furnished services. Reasonable costs are generally based on costs of covered services by various classes of providers in the same geographical area, with the objective to approximate as closely as practicable the actual costs of services furnished to beneficiaries.
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 $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).
Registered Nurse (RN)
A nurse who has graduated from a formal program of nursing education and has been licensed by an appropriate state authority. RNs are the most highly educated of nurses with the widest scope of responsibility, including all aspects of nursing care. See Nurse Practitioner.
Rehabilitation/Rehabilitative Service
Services and treatment designed to restore a patient to a prior level of health or function, or as close to such level as possible.
Rescind
When the insurance company voids (cancels) a policy.
Reserve Days
See Lifetime Reserve.
Residential Care
The provision of room, board and personal care. Residential care falls between the nursing care delivered in skilled and intermediate care facilities and the assistance provided through social services. It can be broadly defined as the provision of 24-hour supervision of individuals who, because of old age or impairments, necessarily need assistance with the activities of daily living.
Residential Care Facility
A facility that primarily provides residential care.
Residential Care Service
Room and board, housing services such as congregate care or adult family home care.
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.
Respite Care Facility
A facility that provides services to those who suffer from cognitive impairment or require assistance with activities of daily living..
Respiratory Therapy
Assists patients with breathing difficulties to reduce fatigue and increase tolerance in performing daily activities.
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.
Rule of 72
See Investment Rule of 72
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Senility
The generalized characterization of progressive decline in mental functioning as a condition of the aging process. Within geriatric medicine, this term has limited meaning and is often substituted for the diagnosis of senile dementia and/or senile psychosis.
Senior Center
Provides a variety of on-site programs for older adults including recreation, socialization, congregate meals, and some health services.
Shortened Benefit Period
A nonforeiture 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 $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 permium 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.
Skilled Nursing Facility (SNF)
Provides 24-hour nursing care for chronically-ill or short-term rehabilitative residents of all ages.
Speech Therapy
Designed to help restore speech through exercises. May be covered by Medicare.
Spend Down
A requirement that an individual use up most of his or her income and assets to meet Medi-Cal (Medicaid) elibility requirements.
Spousal Discount
A premium reduction, usually from 10% to 25% of the premium, that some insurers provide when both a wife and husband purchase long-term care policies. Insurers offering such discounts sometimes do so for two people who permanently reside together whether or not they are spouses.
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.
Subacute Care
A level of care designed for the individual who has had an acute event as a result of an illness, and is in need of skilled nursing or rehabilitation but does not need the intensive diagnostic or invasive procedures of a hospital.
Supportive Service
Home health care services, such as personal care, chore services, homemaker services, and social services.
Substantial Assistance
Hands-on or standby help required to do activities of daily living.
Substantial Supervision
The presence of person directing and watching over another who has a cognative impairment.
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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.
Terminally Ill
When illness, disease, or injury has reached a point where recovery can no longer be expected, and the expectance must be six months or less to qualify for hospice benefits.
Therapeutic
Relating to the treatment of an illness, disease, or condition by remedial agents or methods.
Therapeutic Devices
May include hospital beds, crutches, wheelchairs, ramps, intravenous pumps and respirators.
Third Party Notice
A benefit which lets you name someone who 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, for example.
Toileting
Getting to and from the toilet, getting on or off the toilet, and performing associated personal hygiene.
Transferring
The ability to move into or out of bed, a chair or wheelchair.
Transportation Services
Provides transportation for older adults to services and appointments. May use bus, taxi, volunteer drivers, or van services that can accommodate wheelchairs and persons with other special needs.
Triggers
See Benefit Triggers.
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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 fact amount of your coverage.
Usual, Customary and Reasonable (UC&R)
A term used to refer to the commonly charged or prevailing fees for health services within a geographic area. A fee is generally considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community. "Usual and Customary (R&C)" essentially means the same thing as "Reasonable and Customary (R&C) Charge."
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Ventilator
A ventilator, also known as a respirator, is a machine that pushes air into the lungs through a tube placed in the trachea (breathing tube). Ventilators are used when a person cannot breathe on his or her own or cannot breathe effectively enough to provide adequate oxygen to the cells of the body or rid the body of carbon dioxide.
Vital Statistics
Statistics relating to births (natality), deaths (mortality), marriages, health, and disease (morbidity).
Vulnerability
A risk or hospital or nursing home placement due to ill health, functional impairment, or lack of family support.
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Waiting Period
The period during which no benefits are paid immediately after the policy goes into effect. Sometimes used incorrectly as a synonym for an insurance policy’s elimination period.
Waiver
An attachment to an insurance policy that usually limits or withdraws coverage for a specific illness or condition. Also known as an exclusionary rider.
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.
Long-Term Care Glossary
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