How Do I Qualify for Benefits?

After satisfaction of the waiting/elimination period described below, to be eligible for benefits, the insured must require substantial supervision to protect himself/herself from threats to health and safety due to severe cognitive impairment or must be unable to perform without substantial assistance from another individual at least two out of six activities of daily living (ADLs) due to loss of functional capacity that is expected to last at least 90 days. The activities of daily living are: transferring, bathing, toileting, dressing, eating and continence. Additionally, the insured must be certified by a licensed health care practitioner as a chronically ill individual within the last twelve months, have a written plan of care developed by a licensed health care practitioner and follow the written plan of care. Once a long-term care insurance policy's benefits are triggered, the policy will reimburse the eligible expenses up to the maximum daily benefit selected under the policy until the available policy benefits are exhausted.

Before collecting any policy benefits an insured must also fulfill the waiting period/ elimination period. The "waiting period"/"elimination period" works like a deductible. Waiting periods vary in length, and most long-term care insurance companies offer numerous options, but 60 to 90 day waiting periods are quite common. During the waiting period, an insured is liable for all costs related to their long-term care services. Once the insured has met the requirements for a claim and fulfilled the waiting period and you meet the eligibility criteria outlined above, the long-term care insurance provider will begin paying benefits.

Please note: Long-term care insurance policies vary in coverage and benefits and policies vary by state. Be sure that you clearly understand what the benefit triggers are under any policy you consider. You should contact your professional advisors for legal, tax or accounting advice.

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New York Life Insurance Company

256952HO (TX) Rev. (0304)

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