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Agent:  
Phone number:  
Company:  

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  
In an assisted living facility  
Other  

 

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

For nursing home care
For home health care
For an assisted living facility  
Other  

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  
For an assisted living facility  
Other  

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  
For an assisted living facility  
Other  

8. Are Alzheimer’s disease and other organic mental and nervous disorders covered?

  • Yes
  • No

 9. Does this policy require:

  • An assessment of activities of daily living?
  • An assessment of cognitive impairment?
  • Physician certification of need?
  • A prior hospital stay for nursing home care?
  • Home health care?
  • A prior nursing home stay for home health care?
  • Other?

10. Is the policy guaranteed renewable?

  • Yes

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. Does the policy have a nonforfeiture benefit?

 

15. Does the policy offer an inflation adjustment feature? If so, what is the rate of increase? How often is it applied? For how long? Is there an additional cost?

16. 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,” 2004, America’s Health Insurance Plans