What are the common universal exclusions in a long-term care policy?
Asked by: Dr. Hassan Osinski IV | Last update: April 26, 2025Score: 4.1/5 (9 votes)
Which of the following is excluded in a long-term care insurance policy?
Many long-term care policies exclude coverage for the following: Mental and nervous disorders or diseases (except organic brain disorders) Alcoholism and drug addiction.
Which of the following exclusions would not be permitted in a long-term care insurance policy in California?
Final answer: The LTC insurance exclusion not permitted in California is for A) Alzheimer's disease that begins after the effective date of coverage, as it goes against protections for the elderly who may require care in nursing homes.
Which of the following is not covered under a long-term policy?
The correct answer is option A. Acute care in a hospital is not typically covered under a long-term care policy. Long-term care policies are designed to provide coverage for individuals who require assistance with daily activities and prolonged care due to chronic illnesses, disabilities, or cognitive impairments.
What does long-term care not cover?
Long-term care insurance typically doesn't cover care provided by family members. It also usually doesn't cover medical care costs—those are typically covered by private health insurance and/or Medicare.
48% of Retirees Will Require This Care: Is the INSURANCE worth it?
What are common exclusions found in LTC policies?
- Mental illness, however, the policy may NOT exclude or limit benefits for Alzheimer's Disease, senile dementia, or demonstrable organic brain disease.
- Intentionally self-inflicted injuries.
- Alcoholism and drug addiction.
What is the biggest drawback of long-term care insurance?
One of the biggest drawbacks of getting long-term care insurance is the risk of losing all the premiums you have paid over the years. If you end up not needing long-term care services, you won't be eligible for coverage. This means the money you've spent for coverage goes down the drain.
Which of the following is not an allowable exclusion for long-term care insurance policies?
The correct answer is: b. Acute care Explanation: 1. Acute care is not an allowable exclusion for long-term insurance policies. Acute care refers to the treatment of short-term illnesses or injuries that require immediate medical attention and are typically covered by health insurance policies.
When can a long-term care policy deny a claim?
Long term care insurance claims are exacting and demanding. Claims will be denied if the type of care doesn't match the policy's definition of covered care. AND Claims are regularly denied if your medical paperwork doesn't match the specific policy triggers in your policy.
Which of the following types of care is typically not covered in a long-term care policy?
Final answer: Acupuncture is typically not covered in Long-Term Care policies, while services like skilled care, home health care, and custodial care are covered to meet the needs of senior citizens.
What are the major exclusions of the policy?
The three major types of Exclusions are: Excluded perils or causes of loss. Excluded losses. Excluded property.
Who is the largest payer of long-term care services?
Medicaid is by far the largest payer in the long-term care space, covering approximately 60% of long-term care services across the United States. This government-funded program provides essential financing for low-income individuals who need care but cannot afford it out of pocket.
What must be disclosed in a long-term care policy?
Such outline of coverage shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the principal exclusions, reductions, and limitations contained in the policy; (3) A statement of the renewal provisions, including any reservation in the policy of a right to ...
What are exclusions in health care policies?
Limitations are conditions or procedures covered under a policy but at a benefit level lower than the norm. Exclusions, on the other hand, are conditions or procedures that are completely omitted from coverage.
What disqualifies someone from assisted living?
If a senior could jeopardize the safety and health of other residents, the senior may be denied admission to an assisted living facility. Some of the most common conditions for disqualification include seniors who have severe memory impairments, who need extensive medical care, or who are bedridden.
Which benefit would be typically excluded or limited under a long term care policy quizlet?
Under a Long Term Care policy, which benefit would be typically excluded or limited? Addictive behavior rehabilitation is normally excluded or limited under a Long Term Care policy.
What is excluded in a long term care policy?
Attempted suicide or an intentionally self-inflicted injury. Resulting from alcoholism or drug addiction (except for an addiction to a prescription medication when administered in accordance with the advice of a Physician). War or any act of war, whether declared or not.
What triggers a long-term care claim?
Benefit Triggers
In California, insurance companies must pay LTC benefits when you cannot perform 2 activities of daily living (such as bathing, dressing or eating) or you have a cognitive impairment serious enough to require supervision.
What is the elimination under a long-term care insurance policy?
The elimination period (sometimes called a "Waiting Period" or "Deductible Period") is the period of time you must wait after you qualify for care and are eligible to receive benefits before the company will begin paying or reimbursing you for your covered care.
Which of the following does not have to be disclosed in long-term care policy?
Final answer: The 'reasonable' and 'customary' is not generally required to be explained in the disclosure of a long-term care (LTC) policy.
What is the least expensive type of long-term care?
- Home healthcare: This includes home health aides and any other long-term care support you receive at home.
- Assisted living communities: This type of long-term care provides housing with round-the-clock staff to help with basic daily living activities.
What are 5 items or services not covered by Medicare?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
Why would long-term care insurance be denied?
When it comes to getting long-term care insurance, your current health matters. In fact, one of the biggest reasons people are denied long-term care insurance is because they have a pre-existing medical condition or disability that makes it more likely they'll require care sooner.
What is the disadvantage of long term plan?
Disadvantages of Long-term Goals
Long-term goals can sometimes feel overwhelming, as they require sustained effort and patience, and progress may not be immediately visible. Setting overly ambitious long-term goals can lead to frustration and discouragement if they are not met within the desired timeframe.
Do you pay LTC premiums forever?
Buying LTC insurance is part of a planning process for life and retirement. You need enough income to pay the premiums for the rest of your life regardless of premium increases or life changes, such as the death of your spouse.