California Life-Only & Accident and Health AgentRelated Benefits and ProductsEasy
A client is diagnosed with a severe neurological condition that will require continuous assistance with activities of daily living (ADLs) for an indefinite period. They have a Long-Term Care (LTC) insurance policy with a 90-day elimination period. Assuming the client's condition immediately qualifies for benefits, when will the policy begin paying for covered services?
- AImmediately upon diagnosis, as it is a severe condition.
- BAfter 30 days, as per California's standard waiting period.
- COnly after they have exhausted all personal assets.
- DAfter 90 days from the start of qualifying care.
Show answer & explanationAnswer & explanation
Correct answer: D. After 90 days from the start of qualifying care.
The elimination period in a Long-Term Care insurance policy is the deductible period, during which the insured must pay for their care out-of-pocket before the policy benefits begin. For a 90-day elimination period, benefits start after 90 days of qualifying care.
Why the other options are wrong
- A. LTC policies typically have an elimination period that must be satisfied before benefits begin, regardless of the severity of the condition.
- B. There is no universal 30-day standard waiting period for LTC in California; elimination periods vary by policy.
- C. LTC policies are not typically asset-based and do not require exhaustion of personal assets before benefits commence, unlike some Medicaid programs.
LTC Elimination Period
The elimination period in Long-Term Care insurance is a deductible period, specified in days, during which the insured must pay for their care out-of-pocket before policy benefits begin.
- Functions like a deductible for care services.
- Common periods are 30, 60, 90, or 100 days.
- Choosing a longer elimination period typically lowers premiums.
Memory trick: Long-Term Care: Time to wait, then help awaits.