How a long-term care insurance policy works
From designing your policy to initiating a claim
Making sound choices today can help you find peace of mind tomorrow—that’s what long-term care planning is all about.
Long-term care insurance can help you pay for quality care, as well as give you access to a wide range of caregiver options. In addition, it can play a significant role in your overall financial strategy and help protect retirement income and assets, should you need long-term care services in the future.
It all starts with a few thoughtful decisions.
Designing your policy
There are five basic components of a long-term care insurance policy. The level of coverage chosen from each category will have a direct effect on your total policy premium.1
Simply select one benefit level from each category and you’ll be on your way to a policy that fits your needs.2
Facility services maximum daily benefit (FMDB):
This is the maximum amount of money reimbursed for care in a facility each day you are on claim following the waiting period. You may choose an amount between $50 and $400.
Facilities covered by the policy include nursing facilities and assisted care living facilities.
The benefit period is the length of time you would like benefits to be paid. You may choose one of the following benefit periods: 2 years, 3 years, 5 years, or 7 years.
The policy lifetime maximum or “benefit pool” is the facility services maximum daily benefit multiplied by the benefit period you select. This figure represents your total policy value, or total pool of benefit dollars. For example, $300 a day multiplied by a five-year benefit period would equal $547,500 (5 years x 365 days x $300).
Home and community-based care (HMDB) maximum daily benefit:
Expressed as a percentage of your daily benefit, this valuable feature provides you with the assistance you need to remain in the comfort of your own home or residence. For example, a 50% daily benefit amount for home and community-based care on a $200 maximum daily benefit would equal $100 per day. You can choose from 50%, 80%, and 100% of your daily benefit.
The waiting period is the number of days of covered and paid services you must receive before benefits will become payable. Think of this as the deductible for your policy. You may choose 90, 180, or 365 days. For example, if you choose a 90-day waiting period, you would have to pay for 90 days of eligible long-term care services before you would receive benefits from your policy.
A tool that helps your policy retain or even grow its value over time to keep pace with the cost of care.3
The extras and customization.
Our NYL Secure Care policy includes additional benefits, such as dividend eligibility4 and access to a care planner, at no additional cost. These benefits set us apart and can make a significant difference in your policy’s ability to provide quality coverage.
We also offer a variety of policy riders and inflation-protection options (at additional cost) so you can completely customize your policy to suit your needs. Your Agent can help you understand what’s best for you. As you design your policy, it’s important to keep in mind that we have options for every budget. Some coverage can go a long way.
Qualifying for benefits.
You are eligible to receive benefits once a licensed healthcare professional certifies that you need substantial assistance with two or more of the activities of daily living, which are dressing, eating, continence, toileting, getting in and out of a bed or chair (transferring), and bathing, or you require substantial supervision due to severe cognitive impairment.
Reimbursement begins once a claim is approved and the waiting period, which you select at time of purchase, is met.
The claims process starts the moment you, a family member, or your Agent contacts us to let us know you need to use your policy benefits.
Call 1-800-224-4582 and choose the claims option to initiate a claim, and we can help you through the process.
If your claim is approved, simply submit your receipts to be reimbursed for services covered by the policy, which may include care provided in your own home by a family member or friend.5
Let New York Life help put you in control of your long-term care plan. With the right measures in place, the emotional, physical and financial strain of providing that care doesn’t have to all fall on your loved ones. To learn more, contact your Agent or fill out the “Consult an Agent” form to be connected to one in your local area.
1Premium rates may increase.
2Benefit options may vary by state.
3Inflation protection is available at an additional cost. Options may vary by state.
4Dividends are not guaranteed.
5The caregiver cannot be the insured’s partner, as defined by the policy.
The purpose of this material is solicitation of insurance. An insurance Agent may contact you. Long-term care insurance is issued on policy form ICC14-LTC6. The policy has exclusions and limitations. For costs and complete details of the coverage, contact your Agent or the company. Policy issue is subject to underwriting. A medical exam may be required. New York Life Insurance Company 51 Madison Avenue, New York, NY 10010.