1. What services are covered?

   

• Nursing home care
• Home health care
• Adult day care
• Alternate care
• Respite care
• Other

2. How much does the policy pay per day:

For nursing home care?	$
For home health care?	$
For adult day care?	$
For alternate care?	$
For respite care?	$
Other?	$

3. How long will the benefits last?

In a nursing home
At home

4. Does the policy have a maximum lifetime benefit? If so, what is it?

For nursing home care	$
For home health care	$

5. Does the policy have a maximum length of coverage for each period

of confinement? If so, what is it?

For nursing home care
For home health care

6. How long must I wait before preexisting conditions are covered?

7. How long must I wait before benefits begin?

For nursing home care
For home health care

8. Are Alzheimer's disease and other organic mental and nervous

disorders covered?

• Yes
• No

 9. Does this policy require:                                        

  For nursing home care:                                             

• An assessment of activities of daily living?
  
• An assessment of cognitive impairment?
  
• Physician certification of need?
  
• Other?
  
  

For home health care:

• An assessment of activities of daily living?
  
• An assessment of cognitive impairment?
  
• Physician certification of need?
  
• Other?
  
  

10. Does this policy require a prior nursing home stay for home health

care coverage?

• Yes
• No
  
  

11. What is the age range for enrollment?

12. Is there a waiver-of-premium provision?

For nursing home care
For home health care

13. How long must I be confined before premiums are waived?

14. What does the policy cost?

Per year	With inflation feature: $ Without inflation feature: $
Per month	With inflation feature: $ Without inflation feature: $

Source: Guide to Long-Term Care Insurance, Health Insurance Association of America