THE GATEKEEPERS
A "gatekeeper" is a provision that describes the requirements of eligibility for benefits.  Long-Term Care Policy benefits can be payable for basically one of two reasons:

MEDICALLY NECESSARY
One type of policy uses this basic guideline: A doctor certifies that a policyholder's admission is required due to injury or sickness.

CHRONICALLY ILL
LTC policies that are tax-qualified require that a policyholder be certified as "chronically ill" by a licensed health care practitioner. This means that the policyholder is not able to perform without substantial assistance for at least 2 ADL's for a period of at least 90 days. The requirement of 90-days does not imply a waiting period for payment of benefits or a time during which services are not considered qualified long-term care services. Policies that are tax-qualified may therefore pay benefits from the beginning of services, providing the services are expected to be need for at least 90 days.

ACTIVITIES OF DAILY LIVING (ADL's)
In policies based on ADL's, a physician, nurse, case manager, gerontologist, or other health care professional certifies that a policyholder needs "hands on" help, supervisory "stand by" help, or directional "reminding" help to perform everyday living activities.

ADL's are as follows

INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL's)
A definition of IADL's include the ability to do heavy housework, laundry, meal preparation, grocery shopping, getting around outside, getting to places outside of walking distance, money management, using the telephone, and taking medications.

CONTINUAL ONE-TO-ONE ASSISTANCE
The policyholder is considered to need Continual One-To-One Assistance in performing an Activity of Daily Living when the policyholder needs direct physical assistance somewhere in the process of performing that activity; and the policyholder cannot independently perform the entire activity even with the supports and mechanical aides that are normally available. This is also known as "Hands-On Assistance."

PERSONAL CARE
Means the provision of hands-on services to assist an individual with Activities of Daily Living (such as bathing, eating, dressing, transferring and toileting).

STANDBY ASSISTANCE
Standby assistance means the presence of another person within arm's reach of the individual that is necessary to prevent injury while the individual is performing an ADL.

SUBSTANTIAL ASSISTANCE
Tax-qualified LTC policies must require that a disabled policyholder must need "substantial assistance" in performing at least 2 ADL's in order to receive benefits. "Substantial assistance" is defined as either "hands-on assistance" or "standby assistance."

SUBSTANTIAL SUPERVISION
Under a tax-qualified LTC policy, an insured with cognitive impairment may receive benefits if he or she requires "substantial supervision." This is defined as continual supervision (such as cueing by verbal prompting, gestures, or other demonstrations) that is needed to protect the cognitively impaired individual from threats to his or her health or safety. An example is the need for someone to be present to prevent the individual from wandering.

COGNITIVE IMPAIRMENT
Deterioration or loss in the policyholder's intellectual capacity which creates the need for continual supervision to protect the policyholder or others.

SEVERE COGNITIVE IMPAIRMENT
This is a loss or deterioration in mental capacity that is comparable to Alzheimer's Disease and similar forms of irreversible dementia, and is documented by clinical evidence and standardized tests of memory, orientation as to people, places, and time; and deductive or abstract reasoning.

Tax-qualified policies must require that cognitive impairment be "severe" in accord with this definition.

MENTAL AND NERVOUS DISORDERS
Refers to a mental or emotional disease or disorder of any kind that does not have an organic origin. (Alzheimer's and senile dementia are considered organic.) These "non-organic" mental and nervous disorders and disorders due to alcohol or drug related problems are not covered by most insurance policies.

FUNCTIONALLY DISABLED
A functionally disabled person is one who has cognitive impairment or is unable to perform a prescribed number of activities of daily living (ADL's) as per the insurance policy. Additionally, some insurance policies require that the treatment must be medically necessary before they will pay any benefits.

AGE RESTRICTIONS
LTC policies are generally sold to people between 50 and 79 years of age. Some insurers will sell policies to those over 80 years of age, and several will sell policies to those under 50. Policies sold to those 80 years of age and over sometimes have reduced benefits compared to the standard policy.

ELIMINATION PERIOD (DEDUCTIBLE PERIOD)
The number of consecutive or accumulative days from the start of any confined or nonconfined care before benefits are payable.

PRE-EXISTING CONDITIONS
Waiting period after buying a policy before the policyholder will be covered for any pre-existing conditions.

COVERED NURSING CARE FACILITY (CONFINED) BENEFITS
Policies that offer benefits for all levels of care will pay benefits in a nursing facility that is: Licensed in the state; a charge is being made.

COVERED HOME HEALTH CARE SERVICES (NONCONFINED) BENEFITS
Policies that offer home health care benefits require that they be provided by any state licensed home health care agency or by a licensed nurse, therapist, or dietician. Home health care can be provided anywhere the insured resides, except in a nursing facility or hospital.

HOME CARE AGENCY
Means an agency or organization which provides Home Care and is state licensed (in states where required) or accredited by the National Home caring Council, a Division of the Foundation for Hospice and Home Care, or the Joint Commission on Accreditation of Health Care Organizations, or the National League for Nursing. Individual plan of care records are kept on each patient, there is supervision by a qualified professional (RN or licensed social worker), and the facilities employees receive appropriate specialized training.

HOME HEALTH CARE
Means a program of professional, paraprofessional or skilled care provided through a Home Health Care Agency to a patient in his or her home. Services not included in Home Health Care are those provided to a patient while confined in a hospital, nursing facility or any other facility which charges for room and board.

HOME RECOVERY BENEFITS
Policies that offer a Home Recovery Benefit will pay during a policyholder's convalescence after a nursing home stay.

ADULT DAY CARE CENTERS
An adult day care center is an infrastructure that provides a program of adult day health care and: Is state licensed; operates at least five days a week for a minimum of six hours a day and is NOT an overnight facility.

ALTERNATE CARE FACILITIES
An alternate care facility is one that is licensed (if state licensing is required) and provides 24 hour a day personal care and custodial services by a trained and awake staff to those who suffer cognitive impairment or require help with Activities of Daily Living.

1. It provides 24-hour a day care and services sufficient to support needs resulting from inability to perform Activities of Daily Living or Cognitive Impairment.
2. It is state licensed, if required, to provide the level of care and services being rendered.
3. It has supervision to the extent required by law.
4. It provides three meals a day and accommodates special dietary needs.
5. It has procedures for procuring the services of a doctor or nurse to furnish medical care in case of emergency.
6. It has appropriate methods and procedures to assist in administering prescribed drugs.

The "Alternate Facility" may be described as the following: Assisted Living Facility; Residential Care Facility; Alzheimer's Facility; Adult Foster Home; Domiciliary Care Facility.

ALTERNATE PLAN OF CARE
"Alternate Plan of Care" benefits can include having improvements made to a policyholder's home, such as ramps built for wheelchair access, handrails in a bathroom, kitchen cabinets lowered, if the doctor, patient, patient's family and insurance company determine that this would be more appropriate for all concerned parties and if it is at a lower or equal cost to the nursing home.

CONVALESCENT CARE FACILITY
A skilled nursing facility or an intermediate care facility. The majority of insurance companies require such facilities to be state licensed or Medicare approved. The following services are to be provided by the facility: a doctor available in case of emergency; one full-time nurse and a nurse on duty at all times; strict procedures for handling and administering drugs and other treatments; medical records kept for all patients.

CUSTODIAL CARE
Custodial care can be given in nursing homes, adult day centers, or at home. It helps you with the activities of daily living. People without medical training can give custodial care. This care may involve preparation of meals, help with taking medicines, and other routine activities. Policies do not usually cover custodial care given in rest homes, residence homes, or similar living arrangements. However, most LTC policies pay for custodial care in an approved nursing home, and those with home care benefits pay for custodial care at home.

HOME HEALTH CARE
Services provided by a state licensed agency and includes services provided by a nurse, home health aide, nutritionist, or occupational, speech, respiratory, or physical therapist. Services provided by members of your family, special companions, or homemakers are not usually covered. This care is not covered by all insurance companies. It may, however, be covered as part of the long-term care policy, an option or rider available with the policy, or a separate policy.

HOME HEALTH AIDE
A health worker employed by a Home Health Agency, other than a doctor, nurse, or therapist, who provides help at home with activities of daily living, and in some cases homemaker or companion services.

INTERMEDIATE NURSING CARE
Intermediate care is less intensive than skilled care, and usually needed for a longer period of time. A doctor will order the care and it is supervised by registered nurses. This is care for stable conditions requiring daily but not 24-hour nursing supervision. This level of care provides a planned, continuous program of nursing care that is preventive or rehabilitative in nature.

ELDERCARE LOCATOR
A national hotline service that refers you to local services if you or someone you know needs long term care. The number is 800-677-1116.

NATIONAL INSTITUTE ON AGING
A part of the U.S. National Institutes on Health, the Institute on Aging supports research on the biologic and social aspects of aging, and provides information to the public. The number is 800-222-2225.

RESPITE CARE
Respite care is for the policyholder's primary caregiver. It may mean that the patient receives a temporary overnight stay in a nursing facility or assisted living facility or Home Health Care Services.

SKILLED NURSING CARE
This is for medical conditions requiring care by skilled medical personnel, such as registered nurses and professional therapists. The care must be available 24 hours a day and is ordered by a doctor, usually in accord with a care plan.

CONFINED HOSPICE CARE
This means care received in a hospice care facility that provides a formal program of care for terminally ill patients, on an inpatient basis, as directed by a physician. The treatment must be provided by a hospice care organization that is state licensed or Medicare approved.

HOME HOSPICE CARE
This means a program of care for terminally ill patients that is ordered by a physician and received in the insured's home.

BED RESERVATION BENEFITS
Bed Reservation Benefits may be paid if a policyholder's covered stay is interrupted because the insured is hospitalized for any reason and a charge is made to reserve the policyholder's nursing home or alternate care facility accommodations.

EQUIPMENT PURCHASES
Purchases of medically appropriate equipment.

RESTORATION BENEFITS
The original maximum benefit period restores itself when benefits have not been required for 180 days whether in an institution or home or nonconfined setting.

RECURRING CONDITION
The policyholder may need treatment for a condition that recurs periodically.

PRIOR CARE REQUIREMENTS
Most current policies no longer have this requirement – that they would only pay for nursing home care if you had just been hospitalized or they would only pay for home care if you had been hospitalized or in a nursing home recently. Check the policy for this provision before you buy.

TEMPORARY INSURANCE
Temporary insurance covers the policyholder from the time the coverage is applied for and during the underwriting process. Temporary insurance usually has a specified period of time to remain in force, most commonly 60 days.

CASE MANAGERS
Often a nurse or a social worker trained in helping the elderly. A case manager evaluates a person's need for care, devises a treatment plan, helps with nursing and monitors the care that is given.

GERIATRICS MANAGER
A person who assesses the needs of an elderly person, determines what services they need, arranges for the services, and may check on the person regularly. The geriatric manager is often hired by the concerned immediate family or friend to keep them informed of the elder's status when they cannot be there to do it themselves.

IMMEDIATE FAMILY
Represents a person's spouse, daughter, son, father, mother, sister or brother, granddaughter or grandson, or in-laws.

ACTUAL EXPENSE BASED ON REASONABLE AND CUSTOMARY CHARGES
This provision limits reimbursement to the reasonable and customary charge for care in the policyholder's geographic area.

ACTUAL CHARGES
The carrier will pay the actual daily charge, not to exceed the daily benefit that the policyholder has.

INDEMNITY BENEFIT
When a policy specifies a particular daily benefit, the amount will be paid regardless of what the facility charges for the policyholder's care.

CAREGIVER INDEMNITY BENEFIT OPTION
Allows Home and Community Services Benefits to be payable regardless of who provides the care; i.e., a family member, friend, or other non-professional.

CARE ADVISORY BENEFIT
Means the payment for services of a Care Advisor.

BENEFIT LIMITS
This amount represents the daily benefit times the maximum number of days you can receive for all benefits combined under the policy.

GUARANTEED INCREASE OPTION
Every two years you will have the option of increasing your daily benefit by purchasing an additional $10 of coverage. You will be given an offer on the second policy anniversary and each two-year anniversary thereafter through the tenth anniversary, unless you decline two successive offers (policies may vary). You are guaranteed this offer regardless of your health as long as you are not receiving covered services. No additional underwriting will be required.

DEFERRED OPTION
Deferred Option allows you to increase coverage in the 1st, 3rd, or 5th Policy Anniversary - providing no claim has been incurred. Premiums will be based on your age on the 1st, 3rd, or 5th Policy Anniversary, as applicable. No further evidence of insurability will be required.

DISCOUNT RATE
This is the "time value of money." It is used to convert dollars paid or received in future years to current dollars. The rate is used in calculating the current value of future expenses, benefits or income.

INFLATION RATE
This is the rate at which the cost of long-term care is expected to increase in the future. Historically is rate is 1-2% higher than the overall U.S. inflation rate (e.g. the consumer price index).

CONSUMER PRICE INDEX
CPI (Consumer Price Index) is for all urban consumers published by the United States Department of Labor. It is the cost of grocery items and other goods and services based on a standard established in 1940 and stated in today's dollars.

GUARANTEED RENEWABLE FOR LIFE
The insurance company cannot cancel or refuse to renew a policy as long as the policyholder pays premiums on time.

NONCANCELLABLE
This feature means that a company can never cancel a policy for any reason EXCEPT nonpayment of premiums and that they can never raise the policyholder's premium in the future.

MEDICAL UNDERWRITING
This is the process of judging risk by assessing the medical history of the client from medical records or a physical assessment BEFORE a policy is issued.

HIPAA
The Health Insurance Portability and Accountability Act of 1996 became law on January 1, 1997. The Act specifies requirements that a long-term care insurance policy must meet in order that premiums paid may be deducted as medical expenses, and benefits paid not be considered taxable income.

TAX-QUALIFIED POLICIES
Beginning January 1, 1997, long-term care policies meeting certain requirements qualify for favorable tax treatment. Buyers of tax-qualified (TQ) plans can deduct the premiums if they itemize deductions on their Federal tax return. For 1997, the maximum deductible was $200 if 40 or under, $375 if 41-50, $750 if 51-60, $2000 if 61-69, $2500 if 70+.

Premiums are treated like other health insurance and medical expenses, and must total more than 7.5% of adjusted gross income. If total health expenses are less than this amount, premium deductibility will not reduce your tax.

Also, benefits received from a TQ plan are not taxed, up to $175 a day, while benefits received from a non-TQ plan may be taxable.

CRIMINALIZATION
Under the provisions of the Health Insurance Portability and Accountability Act which became law January 1, 1997, persons who knowingly and willfully dispose of assets in order to become eligible for Medicaid payment of long term care expenses, are subject to criminal penalties, if doing so results in a period of ineligibility for Medicaid benefits. Currently the period of ineligibility is 3 years, or 5 years after transfers to a trust. Thus asset transfers during this period could be subject to such penalties.

PREMIUMS
Premiums are the cost of insurance and depend on your age, the amount of coverage or benefits you choose, and may depend on your current health. A majority of policies allow the insurer to raise the premium in future years, as long as it is raised for all holders of the same policy in the same state.

LEVEL PREMIUM
The premium you pay when you buy a policy will stay constant and will not increase because you get older or if your health changes. It can be raised, however, by the insurer for an entire group of policy holders in a state.

WAIVER OF PREMIUM
If a policyholder is receiving benefits, policy premium payments are stopped. If benefits stop before policy is exhausted, premiums resume and no back payments are required.

LIFETIME WAIVER OF PREMIUM FOR SURVIVOR
In the event of the policyholder's death or a covered spouse's death subsequent to a specified number of years the surviving person may continue the policy in force for the rest of his or her life and all subsequent premiums will be waived.

CONTINUATION FOR ALZHEIMER'S DISEASE AND OTHER FORMS OF COGNITIVE IMPAIRMENTS PROVISIONS
If the carrier receives written notice within a specified period of time usually nine (9) months after the termination date, proof, in the form of doctor's certification, that the policyholder has Cognitive Impairment (including but not limited to Alzheimer's Disease) and payment of all past due premiums for the policy and all riders that were in force, immediately prior to the date of lapse, are paid.

NONFORFEITURE BENEFIT
This benefit returns part of what the policyholder has paid in premiums if the policyholder chooses to cancel the insurance coverage.

FULL NONFORFEITURE BENEFIT
This benefit returns all premiums paid to your beneficiary upon your death (or the second to die with joint coverage). For in-force policies, the rider provides a death benefit equal to the total of premium paid, regardless of any claims paid.

PAID UP BENEFITS
If the policy should lapse due to nonpayment of premium after it has been in force for a specific number of years, you may be eligible for a Paid-up benefit.

PAID UP PREMIUMS
If the policyholder pays a higher premium for a limited number of years, for example, ten (10) or 20 years, or until the policyholder reaches a certain age, at that point the policy will be "paid up." Not all companies offer lifetime rate guarantees during your paid-up period. Check the policy you are considering. This policy is also a non-cancelable policy – (See definition for "NonCancelable).

If you are confined to a nursing home for 120 consecutive days (policies may vary), you will never again have to make another premium payment on your policy. Even if you recover and resume your normal lifestyle, you still will never have to make another payment.

RETURN OF PREMIUM
The carrier will return to the policyholder an amount of cash determined by a specific chart upon the carrier's receipt of the proof of the policyholder's death, or after the carrier receives notice that the policyholder wishes to terminate the policy and claim the return of premium amount.

LOSS RATIO
This is a percentage used by insurers to indicate how much is paid out in benefits for each dollar they take in as premiums.

DETERMINING THE POLICYHOLDER'S TOTAL POLICY PREMIUMS
The policyholder's total premiums are all premiums the policyholder has paid for the policy.

DETERMINING A POLICYHOLDER'S TOTAL POLICY BENEFITS
The total policy benefits are all benefit amounts paid or payable under the policyholder's policy.

SCHEDULE OF BENEFITS
Means a schedule of benefit coverage that is provided to each Covered Person which establishes Premium amounts, Premium payment mode and a summary of the benefits and limitations that apply.

SERVICE PLAN
A written description of the long-term care services appropriate to meet your needs. This plan will identify the type and frequency of services you need. It will also indicate any benefits you will receive under the plan for the services rendered.

THE RETURN FACTOR
The return factor is determined from a table based on the number of full years the policy and this benefit were continuously in force. The carrier will count periods for which the premiums have been waived.

FREE-LOOK PERIOD
If you change your mind after buying a policy, most states allow you to return the policy within 30 days. Get written evidence of this option when you receive the policy.

UNDERWRITING
The underwriting process is when the insurer examines your application to decide whether it is willing to take the risk of insuring you.

RATING CLASS
Means a population segment classified by actuaries as having similar coverage risks.

MEDICARE
A Federal Government program to provide health insurance for everyone over 65. Medicare pays a small amount (with many stipulations) for long-term care if you are receiving skilled or rehabilitative services. It will not pay for "maintenance" care or help with activities of daily living.

MEDIGAP
Medigap or Medicare Supplement policies are private insurance policies that pay for care that is approved but not paid by Medicare. Medigap policies will not pay for services not covered by Medicare.

MEDICAID
This is a joint Federal and State government program to pay medical costs for the poor. If your financial assets and monthly income are below certain allowed levels, Medicaid will pay nursing home and some home care costs if you are disabled.

SPEND DOWN
This is the process of spending your savings on long-term care, in order to qualify for Medicaid benefits. Unmarried people must use up all but $2000 (not including a primary home, a car, personal effects, and burial expenses) before Medicaid will pay. For couples, the spouse not receiving care can keep some of the joint assets. The amount varies from state to state.

PREVAILING EXPENSES
Expenses, fees or charges actually incurred by an Insured Person which do not exceed the Normal Charge made for similar care, service or other items. For the types of services recognized by Medicare, the Normal Charge is the upper level of the Medicare reimbursement rate; and for all other services, the normal charge is 120% of the average charge based on surveys conducted by trained case managers and independent agencies to determine the current costs of all similar services in your community and the surrounding areas, provided to persons with comparable medical conditions or impairments in the locality where they are received. An expense, fee or charge is considered to be incurred on the day on which the care, service or other item forming the basis for it is received.

CAREGIVER TRAINING
Companies will pay up to a specific number of times of the policies daily benefit to train an informal caregiver of your choice to care for you in your home.

CHORE SERVICES
Means assistance a person provides with light or household tasks you would normally perform. This is limited to assistance provided when: you are no longer capable of performing the work or tasks (because of your need for assistance); they are necessary to or consistent with your ability to remain safely at home; and informal unpaid caregiver is not available. This may include such functions as: simple house repairs; taking out the garbage; and related tasks that do not require the services of a trained aide or attendant.

NON-QUALIFIED POLICIES
This type of policy is not intended to meet the definition under section 7702B(b) of the Internal Revenue Code. Benefits received under a Non-Qualified plan may have adverse tax consequences to you. Before you buy this type of policy you may want to consult with a tax advisor about these potential income tax consequences.

PERSONAL BENEFIT ACCOUNT
The total value of your personal benefit account is determined by multiplying your daily maximum by your Benefit Multiplier. If you choose the unlimited option, your personal benefit account is unlimited. If you use less than your full daily amount on any given day, the unused funds remain in your personal account to extend the length of time your benefits will last.

BENEFIT MULTIPLIER
Select a multiplier. This allows you to approximate the minimum number of days a company would pay your full Daily Maximum.

DAILY MAXIMUM
Select the maximum amount you want a plan to pay for each day you need care.

NON-DUPLICATIONS OF BENEFITS
The policy will only pay for covered expenses that are in excess of what Medicare or other governmental health plans (except Medicaid) pay. Most Carriers exclude deductibles and coinsurance under Medicare from their coverage.

SPOUSAL IMPOVERISHMENT
Allows the at-home spouse to keep certain amounts of assets and income. The at-home spouse is allowed to keep one half of the total amount of the assets, not to exceed $81,960, as well as the family home.

INCOME RULES
Income also effects eligibility and it is defined as all income received from any source. Income can be derived from any one or any combination of, the following: Social Security, interest, investments, trusts, rental property, assistance from family members, pensions and annuities. If your income is over a specified amount (which changes every year) you can be denied public assistance.

ACCELERATED DEATH BENEFIT
A life insurance policy option that will pay all or part of the policy's face amount before death. This benefit can pay the cost associated with catastrophic medical conditions, which can include the need for nursing home residency.

ACUTE CARE
Care for illness or injury that has developed rapidly, has pronounced symptoms and is finite in length.

ADULT DAY CARE
Social, recreational and/or rehabilitative services provided in the daytime for persons who cannot remain alone. It includes health and custodial care, and other related support. This care - an alternative to care in the home or in an institution - is given in specified centers on a less than 24-hour basis.

ADULT FOSTER CARE
A live-in arrangement where one adult lives with, and is provided care and/or services, by an unrelated person or family. These arrangements may be certified by the state or managed individually.

AGEISM
Prejudice against people because of their age.

AGING IN PLACE
An older person continues to live at home or within the community, not in an institution.

ALTERNATE CARE BENEFIT
A policy provision which allows for a special arrangement of services specifically designed to allow the person to reside in a setting other than a nursing facility.

ALTERNATE CARE FACILITY
A licensed residence other than a nursing facility where care services are delivered. Examples: a hospice, an assisted living facility, an Alzheimer's facility or Christian Science setting.

ALZHEIMER'S DISEASE
A form of organic dementia resulting in cognitive impairment, first described in 1906 by German neurologist Alois Alzheimer. Specified levels of impairment trigger benefits under the long term care insurance policy.

ALZHEIMER'S UNITS
Special living units within nursing facilities or alternate care facilities specifically providing care for those with Alzheimer's disease.

AMBULATORY CARE
Medical services provided on an outpatient (non-hospitalized) basis. Services may include diagnosis, treatment, surgery and rehabilitation.

ANCILLARY SERVICES
Health care services conducted by providers other than primary care providers.

APHASIA
Loss of the ability to use or understand language.

ASSESSMENT
An evaluation of physical and/or mental status by a health professional. The assessment is a central component in long term care insurance coverage and payment of claims. Upon the initiation of benefits - due either to the loss of two or more of the activities of daily living (ADL'S), or a cognitive impairment, an assessment is performed by a healthcare professional, usually an R.N. This assessment, together with the attending physician notes, determines the level of functional incapacity and plan of care to be followed in assisting the policy holder in performing ADL'S.

ASSISTED LIVING FACILITY
A facility providing room, laundry, some forms of personal care such as help with bathing or dressing, and usually recreation and social services. Licensed by state departments of social services, they're known in some states as Community-Based Residential Facilities or Board and Care Homes. Generally they are less costly than nursing homes. Assisted living facility can also refer to facilities designed specifically for the care of dementia.

CAREGIVER
A person providing assistance to a dependent person because of medical reasons or the person's inability to conduct routine activities of daily living. A primary caregiver is the key person - usually a relative - overseeing and providing care for the incapacitated person. Secondary caregivers are relatives who assist in giving care to the person.

CATASTROPHIC ILLNESS
An illness resulting in a sudden change or significant disruption to a person's normal lifestyle. Such change may be temporary or permanent.

CHRONIC CARE
Care for illness continuing over a long period of time or recurring frequently. Chronic conditions often begin inconspicuously and symptoms are less pronounced than acute conditions. Long term care insurance is designed to assist people who have loss of capacity due to chronic illnesses.

COGNITIVE LOSS
The deterioration or loss of one's intellectual capacity, confirmed by clinical evidence and standardized tests, in the areas of: (1) short term and long term memory; (2) orientation to person, place and time; and (3) deductive or abstract reasoning. This is a trigger for long term care benefits.

COINSURANCE
A portion of incurred medical expenses, usually a fixed percentage, that the policyholder must pay out of pocket. Also referred to as "co-payment."

CONGREGATE HOUSING
Apartment houses or group accommodations that provide health care and other support services to functionally impaired older persons who do not need routine nursing care.

CONTINUING CARE RETIREMENT COMMUNITY
Originally called "life care" communities, these organizations provide living arrangements and services ranging from independent to assisted to institutional care. Often, CCRCs require a large initial cash payment, ongoing maintenance fees, assignment of assets or a combination of all three.

DEMENTIA
Severe impairment of cognitive functions (e.g., thinking, memory and personality). Of the elderly population, 5 to 6 percent have dementia. Alzheimer's disease causes about one-half of these cases; vascular disorders (multiple strokes) cause one-fourth; other dementias are caused by heart disease, infections, toxic reactions to medicines, alcoholism and other rarer conditions according to the National Association of Health Underwriters. Most Dementias are not reversible.

DIAGNOSTIC-RELATED GROUPS (DRGs)
Specific classifications of illnesses into which hospital inpatients are grouped. Under Medicare, hospitals are reimbursed a fixed amount that is determined in advance for each patient admitted for an illness in a given classification.

DISCHARGE PLANNING
Assessment of an inpatient's medical condition for the purpose of arranging for appropriate continuing care upon leaving the facility. This planning includes the length of time the patient will be in the hospital, the expected outcome and whether there are special needs or requirements on discharge.

DURABLE MEDICAL EQUIPMENT
Mechanical devices, equipment and supplies which enable a person to maintain functional ability. Examples include wheelchairs, walkers, and hospital beds.

DURABLE POWER OF ATTORNEY
A person's appointment of a representative to act on his or her behalf via a legal document that remains in effect in the event of incapacity of the grantor.

FRAIL ELDERLY
Elderly persons whose physical and emotional abilities or social support system is compromised in such ways that maintaining a household or social contacts is difficult without regular assistance from others.

FUNCTIONAL AGE
An assessment of age based on physical or mental performance rather than on chronological age.

FUNCTIONALLY DEPENDENT ELDERLY
People who need assistance from another person to manage daily tasks.

GENERIC DRUGS
These drugs have the same active chemical ingredients as brand name drugs (the trade name given to a drug by its manufacturer) but at a lower cost.

GERIATRICS
The study of physical and mental changes in persons as they age - including the diagnostic treatment and prevention of disorders.

HEALTH CARE SURROGATE
A person designated as having a medical durable power of attorney to make medical decisions on behalf of another person.

INCONTINENCE
Inability to voluntarily control bowel or bladder function.

INSTITUTIONALIZATION
A person's admission to an institution, such as a nursing home.

INTERMEDIATE CARE
Care requiring intermittent, less intense skilled professional and personal care services.

JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS (JCAHO)
A private, voluntary accrediting organization for all types of health care providers.

LIVING WILL
A document which enables a person to declare his or her wishes in advance concerning the use of life-sustaining procedures in the event of a terminal illness or injury when the person has become incompetent.

LONG TERM CARE
The physical, mental and social care given to individuals who have severe, chronic impairments. The types of long term care available include nursing home care, alternate facilities and community care options such as adult day care and home health care.

MANAGED CARE
The establishment of control mechanisms before, during, and after delivery of services that ensure high quality and cost-effective care.

MEALS ON WHEELS
A program designed to deliver meals to the homebound.

MEDICARE RISK PLAN
A type of Medicare supplement coverage where the Medicare recipient "assigns" his or her benefits to an HMO. The HMO contracts with the federal government to provide medical services to the Medicare recipient at a captivated rate from the government.

NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS (NAIC)
A national organization of state officials charged with regulating insurance. NAIC has no official power but wields considerable influence. The association was formed to promote national uniformity in insurance regulations.

OCCUPATIONAL THERAPY
Rehabilitation through the teaching of an art or a specific occupation for persons physically or mentally impaired, with the intent to restore functional ability.

OUT OF POCKET EXPENSES
Those health care costs that must be paid for by the policyholder because they are not covered under an insurance contract.

PARTNERSHIPS
A state-level joint public/private sector program that allows consumers to buy an approved long term care insurance policy to conserve some assets before qualifying for Medicaid. States with federally authorized partnerships include Connecticut, New York, Indiana and California. Other states with partnership programs must recover Medicaid costs from the estate of deceased policyholders; i.e., assets are only protected during the insured's lifetime.

PHYSICAL THERAPY
Rehabilitation for disease or impaired motion through the use of physical methods such as heat, hydrotherapy, massage, exercise or mechanical devices.

PHYSICIAN ASSISTANT
A person who works under the supervision of a physician and performs tasks such as taking medical histories and making routine examinations.

POLICY
The legal contract issued by the insurer to the insured that contains all of the conditions and terms of the insurance.

PREFERRED PROVIDER ORGANIZATION(PPO)
An arrangement in which an insurance company contracts with a number of medical care providers to furnish services at lower than usual fees in return for prompt payment and a certain volume of patients.

PRESCRIPTION DRUG
A drug that can be obtained only by means of a physician's written order.

PROFESSIONAL CARE
Services that must be delivered or supervised by a health care professional such as a registered nurse, physical therapist or physician.

REHABILITATION
The goal of restoring disabled policyholders to maximum physical, mental and vocational independence, and productivity commensurate with their limitations.

REIMBURSEMENT
A method of payment in long term care insurance policies. A reimbursement method pays for incurred expenses up to the limits of the policy.

RESPIRATORY THERAPY
Rehabilitative services for respiratory impairments, such as emphysema and chronic bronchitis.

SANDWICH GENERATION
Persons caring for both dependent children and parents or relatives.

SENESCENCE
The normal process of growing old.

SENILE DEMENTIA
An outdated term for dementia, used when dementia was thought to be a normal part of the aging process. Likewise, senility also is an outdated term.

SHORT TERM STAY
Residence in a nursing facility usually for rehabilitative or convalescent purposes.

SKILLED CARE
The highest degree of medical care. The patient is under the supervision of a physician, care is provided 24 hours a day, and the facility has a transfer arrangement with a hospital. It's the only type of care eligible for reimbursement in a skilled nursing facility under Medicare.

SOCIAL SERVICES
Advisory and counseling services usually provided by social workers to assist persons with problems that concern housing, transportation, meals, etc.

SPEECH THERAPY
Rehabilitative services for those with speech impairments.

SUB ACUTE CARE
Assistance provided by nursing homes for health services such as stroke rehabilitation and cardiac care for post-surgery that offers a lower cost alternative to hospital treatment of the same kind.

UNDERWRITERS
Insurance professionals who determine if and on what basis an insurer will accept an application for insurance.