Understanding How Long-Term Care Benefit Triggers Are Implemented in the Private Insurance Setting
This policy brief provides information about how long-term care insurers implement benefit eligibility triggers in the private insurance market. The way in which companies have operationalized benefit eligibility triggers can inform the development of regulations for the CLASS Plan.Date Updated: 04/06/2011
In order to better understand in a more concrete way how insurers apply benefit eligibility triggers1, LifePlans conducted a structured survey with key individuals involved in the claims management process from 13 major long-term care insurance carriers representing the vast majority of policies sold in the market. We also examined a set of long-term care (LTC) insurance contracts from several of the largest insurance companies selling in the market today to understand if and how these contracts are similar to or different from regulations governing LTC insurance contracts and each other. The key regulations have been developed by the National Association of Insurance Commissioners (NAIC) and adopted by a majority of the states where private LTC insurance is sold. The regulation governing private LTC insurance is the NAIC Model Regulation, which was adopted in 1986 and updated over the years…
Download the publication for all visuals and complete references.
This policy brief provides background on the historical development of benefit eligibility triggers in the private long-term care insurance market. Understanding how these triggers came into being can provide important information to those charged with implementing the CLASS Plan.
This policy brief provides information on the benefit eligibility assessment process in the private long-term care insurance industry. It focuses on how long-term care insurers use the information in the adjudication process, who is involved in the process, and how activities of daily living and cognition are assessed.
This policy brief identifies the elements states use for an assessment of a person’s physical and cognitive limitations and need, and compares these elements to the requirements of the CLASS Plan.