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In order to receive benefits from your long-term care insurance policy you meet two criteria: the Benefit Trigger and the Elimination Period.

Benefit triggers are the criteria that an insurance company will use to determine if you are eligible for benefits. Most companies use a specific assessment form that will be filled out by a nurse/social worker team. Benefit triggers:

  • Are the criteria insurance policies use to determine if you are eligible for long-term care benefits
  • Are determined through a company sponsored nurse/social worker assessment of your condition.
  • Usually are defined in terms of Activities of Daily Living (ADLs) or cognitive impairments
  • Most policies pay benefits when you need help with two or more of six ADLs or when you have a cognitive impairment
  • Once you have been assessed, your care manager from the insurance company will approve a Plan of Care that outlines the benefits for which you are eligible.

The "elimination period" is the amount of time that must pass after a benefit trigger occurs but before you start receiving payment for services. An elimination period:

  • Is like the deductible you have on car insurance, except it is measured in time rather than by dollar amount
  • Most policies allow you to choose an elimination period of 30, 60, or 90 days at the time you purchased your policy
  • During the period, you must cover the cost of any services you receive
  • Some policies specify that in order to satisfy an elimination period, you must receive paid care or pay for services during that time

Once your benefits begin:

  • Most policies pay your costs up to a pre-set daily limit until the lifetime maximum is reached
  • Other policies pay a pre-set cash amount for each day that you meet the benefit trigger, whether you receive paid long-term care services on those days or not
  • These "cash disability" policies offer more flexibility but are potentially more expensive

Last modified on 02/18/2020