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…

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