So you finally decide to purchase a long term care (LTC) policy, you file it away and hope you never need to use it. However, if you do find yourself in the situation where you need care, you should know how you can qualify to begin receiving your benefit payment. As we discussed in a previous post, you will have an elimination period that you have selected, and you will first need to satisfy that prior to getting paid.
There are two ways to qualify for benefit elegilibity, physical need and mental need. In terms in the physical needs, upon diagnosing you, your licensed health care practitioner (this can be your medical doctor, nurse practitioner, or social worker) must certify you are chronically ill and that due to your illness, age, or infirmity, that your need help with a minimum of 2 Activities of Daily Living (ADLs). ADLs include bathing, dressing, toileting, continence, eating and transferring without substantial assistance of another person. It doesn't matter what causes the need, it could be a car accident, a fall that causes a broken hip, or just mobility issues.
Qualifying with respect to mental needs requires the health care practitioner to certify you will need supervision due to any cognitive impairment (such as dementia, senility, Alzheimer's etc) that would cause safety concern.
If something does happen that causes you to need help, consult with your health care professional. Make your health care professional aware of the fact that you have an LTC insurance policy and provide them with your broker/agent's contact information. Your your broker/agent can work with your doctor and the insurance company to facilitate the process to determine if you can receive benefits.